AB0348 PREVALENCE AND SAFETY OF BIOLOGIC THERAPY IN A CHILEAN COHORT OF RHEUMATOID ARTHRITIS PATIENT, A RETROSPECTIVE STUDY
Authors: Silvana Saavedra, Felipe Reyes, Claudia Hernandez, Karen Vergara, Maria Luisa Molina, Annelise Goecke
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Interstitial lung disease (ILD) is a common extra-articular condition in rheumatoid arthritis (RA). New-onset ILD or ILD worsening has also been reported as a possible consequence of biologic therapy. These associations are based on case reports. The present study evaluated ILD prevalence and exacerbation among users of abatacept (T-cell inhibitor), rituximab (B-cell inhibitor), and anti-TNFα agents in a cohort of adult RA patients. <h3>Objectives</h3> In the present study, we aimed to assess the safety of biologic therapy in patients with ILD associated to RA and patients without a history of ILD. <h3>Methods</h3> Data from RA patients beneficiaries of the Ley Ricarte Soto (LRS) program, at the Hospital Clínico de La Universidad de Chile, who received abatacept, rituximab, or anti-TNFα agents for at least a year, were reviewed. <h3>Results</h3> Seventy four patients were reviewed retrospectively between January 2016 and December 2018 (55 female; mean disease duration, 7 years; mean age, 55 years). Mean (SD) DAS<sub>28 ESR</sub> was 6.9 (±0.1) previously to initiate therapy. RA was seropositive in 65 patients (87.8%). Eighteen patients (24.3%) had been previously diagnosed with ILD, with a median duration of 4 years. Most common patterns of RA-associated ILD were UIP (n=5 [46%]) and CPFE (n=3 [23.1%]). Patients with ILD at baseline as compared to patients without history of ILD were more frequently males (27.8% vs 7.5%, p &lt; 0.05), had an older age (64+12 vs 52+13, p &lt; 0.005), a higher positivity of anti-cyclic citrullinated protein antibodies (CCP) (87.5% vs 80%, p &lt; 0.005) and a more frequent history of smoking (50% vs 28%, p &lt; 0.005). The treatment received by patients with RA-associated ILD previously to start biologics under LRS program were: metotrexate [MTX] (n=5), leflunomide [LFN] (n=14), sulfasalazine [SSZ] (n=8), etanercept [ETN] (n=1), adalimumab [ADA] (n=1), abatacept ABA (n=3) and rituximab [RTX] (n=1). When the patients were enrolled to LRS program 83.3% received abatacept, 11.1% anti-TNFα agents and 5.5% rituximab. All patients with RA-associated ILD remained stable at 1 year follow-up. RA patient without ILD who started biologic therapy did not had ILD at 1 year follow-up. <h3>Conclusion</h3> There were no significant differences in the risk of complications between patients with a baseline history of ILD receiving different biologic agents. The present study found that male sex, older age, seropositive RA and patients with a history of smoking, were at increased risk for developing ILD. These data are largely consistent with those of the existing literature. Patients without a history of ILD did not develop pulmonary complications, but these data may be affected by the short follow-up window. Further studies are needed to evaluate the risk of RA-associated ILD and its complications. <h3>References</h3> [1] Curtis, J (2015). Incidence and complications of interstitial lung disease in users of tocilizumab, rituximab, abatacept and anti-tumor necrosis factor α agents, a retrospective cohort study. Arthritis Research &amp; Therapy17:319. [2] Fernández-Díaz, C (2018). Abatacept in patients with rheumatoid arthritis and interstitial lung disease: A national multicenter study of 63 patients. Seminars in Arthritis and Rheumatism48: 22–27. [3] Shaw, Megan (2015). Rheumatoid arthritis-associated lung disease. European Respiratory Review24: 1-16. <h3>Disclosure of Interests</h3> Silvana Saavedra: None declared, Felipe Reyes: None declared, Claudia Hernandez: None declared, Karen Vergara: None declared, Maria Luisa Molina Speakers bureau: Novartis, Annelise Goecke Consultant for: Roche, abbvie, novartis, Phizer, Paid instructor for: Roche, Speakers bureau: Roche, Novartis, Abbvie, pfizer