Abatacept in interstitial lung disease associated with rheumatoid arthritis: national multicenter study of 263 patients
Authors: Fernández-Díaz Carlos , Castañeda Santos , Melero-González Rafael B , Ortiz-Sanjuán Francisco , Juan-Mas Antonio , Carrasco-Cubero Carmen , Casafont-Solé Ivette , Olivé Alejandro , Rodríguez-Muguruza Samantha , Almodóvar-González Raquel , Castellanos-Moreira Raul , Rodríguez-García Sebastian C , Aguilera-Cros Clara , Villa Ignacio , Ordóñez-Palau Sergio , Raya-Alvarez Erique , Morales-Garrido Pilar , Ojeda-García Clara , Moreno-Ramos Manuel J , Bonilla Hernán María Gema , Hernández Rodríguez Iñigo , López-Corbeto Mireia , Andreu José L , Jiménez de Aberásturi Juan R D , Ruibal-Escribano Ana , Expósito-Molinero Rosa , Pérez-Sandoval Trinidad , López-Robles Ana María , Carreira-Delgado Patricia , Mena-Vázquez Natalia , Urruticoechea-Arana Ana , Peralta-Ginés Cilia , Arboleya-Rodríguez Luis , Narváez García F Javier , Palma-Sánchez Deseada , Cervantes Pérez Evelin C , Maiz-Alonso Olga , Alvarez-Rivas María N , Fernández-Melón Julia , Vela Casasempere Paloma , Cabezas-Rodríguez Ivan , Castellvi-Barranco Iván , González-Montagut Carmen , Blanco-Madrigal Juan , Del Val-Del Amo Natividad , Fito María C , Rodríguez-Gómez Manuel , Salgado-Pérez Eva , García-Magallón Blanca , Hidalgo-Calleja Cristina , López-Sánchez Ruben , Fernández-Aguado Sabela , Fernández-López Jesús C , Castro-Oreiro Sonia , Serrano-García Isabel , García-Valle Andrea , Romero-Yuste Susana , Expósito-Pérez Lorena , Pérez-Albadalejo Lorena , García-Aparicio Angel , Quillis-Marti Neus , Bernal-Vidal José A , Loricera-García Javier , Hernández José L , González-Gay Miguel A , Blanco Ricardo 
Published: August 2020

Objective

To assess the efficacy of abatacept (ABA) in RA patients with interstitial lung disease (ILD) (RA-ILD).

Methods

This was an observational, multicentre study of RA-ILD patients treated with at least one dose of ABA. ILD was diagnosed by high-resolution CT (HRCT). We analysed the following variables at baseline (ABA initiation), 12 months and at the end of the follow-up: Modified Medical Research Council (MMRC) scale (1-point change), forced vital capacity (FVC) or diffusion lung capacity for carbon monoxide (DLCO) (improvement or worsening ≥10%), HRCT, DAS on 28 joints evaluated using the ESR (DAS28ESR) and CS-sparing effect.

Results

We studied 263 RA-ILD patients [150 women/113 men; mean (s.d.) age 64.6 (10) years]. At baseline, they had a median duration of ILD of 1 (interquartile range 0.25–3.44) years, moderate or severe degree of dyspnoea (MMRC grade 2, 3 or 4) (40.3%), FVC (% of the predicted) mean (s.d.) 85.9 (21.8)%, DLCO (% of the predicted) 65.7 (18.3) and DAS28ESR 4.5 (1.5). The ILD patterns were: usual interstitial pneumonia (UIP) (40.3%), non-specific interstitial pneumonia (NSIP) (31.9%) and others (27.8%). ABA was prescribed at standard dose, i.v. (25.5%) or s.c. (74.5%). After a median follow-up of 12 (6–36) months the following variables did not show worsening: dyspnoea (MMRC) (91.9%); FVC (87.7%); DLCO (90.6%); and chest HRCT (76.6%). A significant improvement of DAS28ESR from 4.5 (1.5) to 3.1 (1.3) at the end of follow-up (P &lt; 0.001) and a CS-sparing effect from a median 7.5 (5–10) to 5 (2.5–7.5) mg/day at the end of follow-up (P &lt; 0.001) was also observed. ABA was withdrawn in 62 (23.6%) patients due to adverse events (n = 30), articular inefficacy (n = 27), ILD worsening (n = 3) and other causes (n = 2).

Conclusion

ABA may be an effective and safe treatment for patients with RA-ILD.