Background Anti-TNFα drugs and several conventional disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate (MTX) have been involved in the development of Interstitial Lung Disease (ILD).
Objectives Our aim was to assess the efficacy and safety of Rituximab (RTX) in RA patients with ILD.
Methods Multicenter study of RA patients with ILD treated with RTX. ILD was diagnosed by high-resolution computed tomography (HRCT). RTX was used at standard dose (1 gx2 and premedication with iv Methylprednisolone for a six month interval. We assess the the following variables: a) 1-point change in the degree of dyspnea according to the Modified Medical Research Council (MMRC); b) FVC improvement ≥10%; and improvement ≥10% in DLCO; c) radiological changes in HRCT scan, and d) changes in the joint assessment measured by DAS28 score.
Results We studied 18 patients (13 women /5 men) with ILD associated to RA. The mean age±SD was 62.8±11.0 years. The median [IQR] to progression of RA was 5.25 [2–12.8] years. They had received the following DMARDs previously; MTX (n=11), Leflunomide (LFN) (n=9) mycophenolate (MMF) (n=1) sulfasalazine (SSZ) (n=5), hydroxichloroquine (HCQ) (n=4), azathioprine (AZA) (n=1), gold salts (n=1), D-penicillamine (n=1), cyclophosphamide (n=1). 7 patients had previously received biological drugs. RA was seropositive in 16 cases (89%). Besides HRCT, the diagnosis of ILD was confirmed by biopsy in 4 patients. In 2 patients ILD was drug-related: MTX (n=2). RTX was prescribed as monotherapy (n=7) and combined with DMARDs (11. The DMARDs prescribed were: LFD (4), SSZ (2), MTX (3), HCQ (1), AZA (1) MMF (1). A significant improvement of the dyspnea was observed. FVC and HRCT showed an improvement in the period between 6 and 12 months. DLCO remained stable in the majority of the patients (%). DAS28 also improved.
After a follow-up of 12 months, the only serious adverse effect was a severe Infection respiratory.
Conclusions RTX seems to be an effective and relatively safe treatment in RA patients with ILD. However, these data should be verified in prospective and randomized studies.
Disclosure of Interest None declared