Background Roughly 10-30% of rheumatoid arthritis (RA) patients reportedly develop pulmonary complications. These patients are at increased risk of MTX or biologics-induced damage, which often becomes problematic for RA treatment. Abatacept (ABT) has been reported to have relatively few adverse events, and is often used in clinical settings in patients with pulmonary complications. Given the paucity of studies on the safety of ABT, however, accumulation of safety data under actual clinical settings is warranted.
Objectives In the present study, we examined the persistence rates and treatment effects of ABT in patients with interstitial lung disease.
Methods We divided 365 RA patients registered in the Tsurumai Biologics Communication Registry who used ABT for ≥52 weeks according to whether they had interstitial lung disease (ILD group: n=48) or not (N group: n=317). We then compared the continuation rates, incidence of adverse events, and disease activity between the two groups.
Results No significant differences were found between groups with regard to mean age (ILD group, 66.7±8.6; N group, 64.6±12.4), disease duration (ILD group, 11.5±9.2; N group, 11.9±13.8), or concomitant dose of MTX (ILD group, 7.8mg/week; N group, 7.5mg/week) at the time ABT was initiated, but significant differences were found in the percentage of women (ILD group, 65.9%; N group, 81.4%), concomitant use rates of MTX (ILD group, 21.3%; N group, 52.9%), concomitant use rates of steroid (ILD group, 65.2%; N group, 51.8%), CRP (ILD group, 2.8±3.1; N group, 2.0±2.5), or DAS28-CRP (ILD group, 4.7±1.3; N group, 4.3±1.3). The continuation rates for 52 weeks were 79.2% and 80.8% in the ILD and N groups, respectively (Figure 1a). Adverse events occurred in 2 (4.17%) and 14 (4.42%) patients in the ILD and N groups, respectively (Figure 1b). No pulmonary complications occurred after ABT administration in the ILD group, but 2 patients in N group had interstitial pneumonia. Treatment was discontinued due to insufficient response in 7 (14.6%) and 38 (12.0%) patients in the ILD and N groups, respectively. None of these were significantly different by group. Mean DAS28-CRP significantly improved in both groups (Figure 2), from 4.7 at ABT initiation to 3.2 at 52 weeks in the L group (P<0.001), and from 4.3 to 3.0 in the N group (P<0.001). Achievement of those with low disease activity also increased, from9.1% at ABT initiation to 41.8% at 52 weeks in the ILD group, and from 10.7% to 45.5% in the N group.
Conclusions The safety, treatment effects, and continuation rates of ABT were similar among RA patients with and without interstitial lung disease. Because of pulmonary complications, MTX concomitant rate of ILD group was significantly lower than that of N group. It was reported that the influence of concomitant MTX in ABT therapy is small. Thus ILD group would have been able to obtain the similar effects to N group. Use of ABT is beneficial even in patients with pulmonary complications, under close consideration of the risks involved.
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Disclosure of Interest None declared