AB0418 INTERSTITIAL LUNG DISEASE IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH TOFACITINIB
Authors: Marisel Bejarano, Maria Natalia Tamborenea, Mario Alberto Goñi, Lina Saldarriaga, Cecilia Pisoni, Rodrigo Garcia Salinas, Mariana Salcedo, Claudia Helling, Adrian Salas
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> The presence of interstitial lung disease (ILD) is a common extra-articular manifestation in patients diagnosed with Rheumatoid Arthritis (RA), dyspnea being its cardinal symptom. Several of the drugs commonly used to treat this condition, such as TNF inhibitors (anti-TNF) and Disease Modifying Antirheumatic Drugs (DMARDs), have been implicated in the development or exacerbation of ILD. In regard to Tofacitinib, results of post hoc analysis of its pivotal and extension studies report a numerically lower ILD incidence rate in the group that received this drug compared with placebo. <h3>Objectives:</h3> To describe the evolution of dyspnea, spirometric parameters, DLCO and high resolution computed tomography (HRCT) findings in patients with RA diagnosis with associated PID who received Tofacitinib for a period of 12 months. <h3>Methods:</h3> Patients with a diagnosis of RA who fulfilled criteria ACR 1987/ACR-EULAR 2010, with interstitial lung disease previously diagnosed from clinical findings, spirometry and/or HRCT were included. Tofacitinib was used in dose of 10 mg/day orally. Design: Descriptive, retrospective, multicentric study. The following variables were analyzed: change at 12 months from baseline in the degree of dyspnea (according to the modified scale of dyspnea MMRC), forced vital capacity (FVC), DLCO and findings in HRCT. Continuous variables were reported as mean and standard deviation or median and interquartile range as appropriate. The categorical variables were reported as percentages. <h3>Results:</h3> Fifteen patients were included. 60% (n: 9) were women. The mean age was 64.4 years (± 10.92). The median time of evolution of RA was 9 years (IQR: 4-40). The median time of evolution of interstitial lung disease was 4 years (IQR: 1-24).13% (n: 2) of the patients were receiving methotrexate (MTX) at the time of evaluation, 60% (n: 9) of the patients had previously received it. 80% (n: 12) had previously received DMARD different from MTX. 33% of the patients (n: 5) had received previous biological treatment. All patients received tofacitinib at a dose of 10mg/day. 47% of patients (n = 7) received tofacitinib monotherapy and 53% (n = 8) received it combined with DMARDsc. 27% (n: 4) of the patients had grade 3-4 dyspnea at baseline.Improvement in the dyspnea scale was observed in 8 patients, while in the rest, it remained stable. The forced vital capacity (FVC) at baseline was &lt;80% in 5 patients and&gt; 80% in 2 patients. At 12 months, 4 patients achieved a FVC&gt; 80%.The average of DLCO at baseline was 45.6 (± 18.84), with an improvement of 30% at 12 months in 4 patients. No progression of the disease was observed in the HRCT at 12 months in any of the patients evaluated. <h3>Conclusion:</h3> The present preliminary study was performed with patients of daily practice, not being available in all cases, the corresponding respiratory functional examinations. However, despite these limitations, none of the patients showed worsening of dyspnea, with improvement in some patients. Regarding respiratory functional examinations and DLCO, not only they remained stable after treatment in the majority of patients evaluated, but 4 patients presented improvement with respect to baseline parameters. It is necessary to perform more studies, with systematized controls of the pulmonary function and images, to corroborate this hypothesis. Disclosure of Interests: Marisel Bejarano: None declared, Maria Natalia Tamborenea: None declared, Mario Alberto Goñi: None declared, Lina Saldarriaga: None declared, Cecilia Pisoni: None declared, Rodrigo Garcia Salinas: None declared, Mariana Salcedo: None declared, Claudia Helling Employee of: I am an employee of Pfizer, Adrian Salas Consultant for: Pfizer, Employee of: I am an employee of Pfizer