AB0803 A real life experience on the efficacy and safety of mycophenolate mofetil in connective tissue disorder associated interstitial lung disease – a retrospective study
Authors: S. Santhanam, V. Rahulan
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Interstitial lung disease(ILD) is one of the common extra articular manifestations of various connective tissue disorders(CTD). We don't have enough evidence on the drugs used, except for ILD in systemic sclerosis and the results of the same has been extrapolated to other diseases. Mycophenolate mofetil(MMF) has antiproliferative and anti fibrotic action in addition to anti inflammatory property and hence we wanted to study the efficacy and safety of MMF in our diverse cohort of CTD-ILD. <h3>Objectives</h3> To study the efficacy and safety of mycophenolate mofetil (MMF) in a diverse cohort of patients with connective tissue disease(CTD) associated interstitial lung disease(ILD). <h3>Methods</h3> This is a retrospective observational study with records of outpatients with CTD associated ILD were screened from <sup>Oct 2014</sup> to .<sup>Dec 2017</sup> Among them, patients with imaging (HRCT chest) documented ILD were included. All patients underwent detailed clinical assessment, serological investigations (baseline blood test, erythrocyte sedimentation rate, C – reactive protein, rheumatoid factor, ACPA Ab, antinuclear antibody, ANA profile, complements), urine routine, pulmonary function test(PFT), HRCT chest and echocardiogram. The response of ILD to treatment(follow up of 2 years) was assessed clinically, radiologically and by PFT. <h3>Results</h3> 54 patients were identified with CTD-ILD of which 33 patients were on MMF. 13 patients were diagnosed with MCTD, 12 with RA, 3 with diffuse cutaneous systemic sclerosis, 2 with SSc/myositis overlap, 1 with primary sjogren's syndrome, 1 with SLE/Sjogren's overlap and 1 with lung dominant CTD(Scl 70+ve). The cohort was divided in to 3 groups – MCTD, RA and others (SSc predominant). Among patients with MCTD, 10 had NSIP pattern of ILD, 3 UIP. In RA, 7 had NSIP and 5 UIP and among others 7 NSIP and 1 UIP. The mean FEV1 and FVC values over 2 years and the treatment response has been discussed in table 1 and Figure 1. FEV1 and FVC had high positive correlations (Pearson correlation, p&lt;0.05) with treatment for all groups of diseases. The values go together in the positive direction with treatment. Among the groups, all patients who improved had NSIP pattern and all who worsened had UIP. Though there were numerical differences in the mean values of FEV1 and FVC between two groups (NSIP and UIP), it was not statistically significant (paired 't' test, p&gt;0.05). There was no significant difference in FEV1 and FVC values with treatment between the three groups (one way ANOVA test). <h3>Conclusions</h3> Treatment with MMF over a median duration of 24 months stabilised the ILD in majority. MMF appears to be efficacious, safe and well tolerated in our diverse cohort of CTD-ILD and needs to be evaluated further in prospective studies with a bigger sample size. <h3>Reference</h3> [1] Fischer A, Brown KK, Du Bois RM, et al. Mycophenolate Mofetil Improves Lung Function in Connective Tissue Disease-associated Interstitial Lung Disease. The Journal of rheumatology. 2013;40(5):640–646. <h3>Disclosure of Interest</h3> None declared