Background Interstitial Lung Disease (ILD) is a severe extraarticular manifestation of rheumatoid arthritis (RA). AntiTNFα drugs and conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate (MTX) have been involved in the development of ILD. IL6 has been implicated in the pathogenesis of ILD (Kobayashi J et al). However, a fatal case of exacerbation of ILD has been described with tocilizumab (TCZ) (Kawashiri SY el at).
Objectives Our aim was to assess the efficacy and safety of TCZ in ILD associated with AR.
Methods Multicenter study of RA patients with ILD treated with TCZ. ILD was diagnosed by high-resolution computed tomography (HRCT). TCZ was used at standard dose (8 mg/k/iv/4 weeks). We have analyzed the following variables: a) 1-point change in the degree of dyspnea according to the Modified Medical Research Council (MMRC); b) Forced Vital Capacity (FVC) improvement ≥10%; and improvement ≥10% in DLCO; c) HRCT, and d) joint assessment (DAS28 score).
Results We studied 12 patients (9 women/3 men) with ILD related to RA. The mean age±SD was 57.1±16.1 years. The mean evolution of RA was 9±5.8 years. The patients had previously received the following DMARDs; MTX (n=12), leflunomide (LFN) (8) sulfasalazine (SSZ) (3) hydroxichloroquine (HCQ) (1) azathioprine (AZA) (2), gold salts (2). In addition, 11 patients had previously received biological drugs: adalimumab (4) anakinra: (1), etarnecept (4), rituximab (4), infliximab (1), certolizumab (1), abatacept (1). RA was seropositive in 11 cases (92%). Besides HRCT, the diagnosis of ILD was confirmed by biopsy in 4 patients. In 2 patients ILD was drug-related: MTX (n=2). TCZ was prescribed in monotherapy (n=8) or combined with other DMARDs (4). These DMARDs were: LFN (2), MTX (1), AZA (1). In many patients the dyspnea and DLCO remain stable (Table). After a follow-up of 12 months, 2 patients withdrew TCZ, 1 patient for ILD worsening and 1 patient for joint inefficacy.
Conclusions In our knowledge, this is the largest series that assess the EPID associated with RA treated with TCZ. We observed that in many cases pulmonary involvement remains stable.
Kobayashi J et al. Chest 1995; 108: 311.
Kawashiri SY el at. Rheumatol Int 2012; 32: 4023–6.
Disclosure of Interest None declared