POS0564 THE EFFECT OF ARTHRITIS TREATMENT ON THE COURSE OF RHEUMATOID ARTHRITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE FOCUSING ON BIOLOGIC DMARDS: FROM A PROSPECTIVE COHORT STUDY (PART 5)
Authors: S. H. Chang, J. S. Lee, J. S. Lee, C. H. Park, M. U. Kim, Y. J. Ha, E. H. Kang, Y. A. Lee, Y. Park, J. Y. Choe, E. Y. Lee
Journal: Annals of the Rheumatic Diseases (2021)

Background: Interstitial lung disease (ILD) is a severe extra-articular manifestation of rheumatoid arthritis (RA). However, the effect of RA treatment on the course of ILD is not yet known. Objectives: To assess the effect of RA treatment on the course of lung physiology of RA-focusing on biologic DMARDs treatment. Methods: The Korean Rheumatoid Arthritis ILd (KORAIL) cohort is the prospective observational cohort and aims to investigate the natural course of RAILD. Based on either 1987 or 2020 ACR criteria, patients diagnosed with RA and ILD based on CT scan were recruited from six tertiary medical hospitals in Korea since January 2015. RA disease activity was assessed using disease activity (DAS)28-ESR and CRP, annually. Pulmonary function tests (PFT), including FVC and DLCO were conducted annually. In the current study, we analyzed patients who completed a 2-years follow-up or had died during those terms till October 2020. They classified patients into three groups: patients treated with abatacept ≥24 weeks ever (Group 1), those with other bDAMRDs ≥24 weeks ever (Group 2), and those without any bDMARDs or with bDMARDs &lt;24 weeks (Group 3). Results: Of a total of 125 patients who completed 2-year follow-up, 21 patients were classified as Group 1, 26 for Group 2, and 78 for Group 3. The mean age or the number of patients with ≥ 65-year-old was comparable between groups(Table 1). The mean duration since RA diagnosis was shorter in Group 3, but that since ILD diagnosis was comparable. DAS28-ESR score was comparable between Group 1 and 2 at enrollment, so was in 1-year-follow-up (p=0.75) and 2-year-follow-up (p=1.00). FVC and % of the predicted value in FVC, FEV1, and DLco were also comparable among the three groups at enrollment. The numbers of patients with ≥10-point decline in % of FVC predicted was 2 (10.0%) for Group 1, 1 (3.8%) for Group 2, 3 (3.9%) for Group3 during the first 1-year follow-up, and 3 (15.8%), 3 (11.5%), 10 (14.1%) during the last 1-year follow up. The percent of FVC predicted was 81.6 ± 17.5 %, 87.4 ± 17.9 %, 85.2 ± 17.7 % for Group 1,2 and 3, respectively, at 1-year-follow-up, and 79.5 ± 18.8 %, 89.0 ± 16.8 %, 83.5 ± 17.3 % at 2-year-follow-up. (Figure 1A). The percent of DLco predicted was 75.5 ± 23.4 %, 66.7 ± 18.1 %, 67.5 ± 16.7 % for Group 1,2 and 3, respectively, at 1-year-follow-up, and 74.0 ± 23.7 %, 69.1 ± 18.9 %, 67.0 ± 18.5 % at 1-year-follow-up (Figure 1B). Conclusion: Treatment of bDMARDs did not exacerbate FVC than without bDMARDs treatment and mitigated the decline of DLCO compared to without bDMARDs treatment during 2-year-follow-up. Table 1. Clinical characteristics at enrollment (V1) Total Group 1. Group 2. Group 3. P N 125 21 26 78 Age at enrollment 65.9±8.2 66.0±8.8 63.9±8.0 66.6±8.1 0.34 65, n (%) 72 (57.6) 13 (61.9) 11 (42.3) 48 (61.5) 0.21 Female, n (%) 89 (71.2) 16 (76.2) 17 (65.4) 56 (71.8) 0.71 RA duration, years 8.0±8.4 9.6±6.6 9.2±9.0 7.2±8.6 0.05 ILD duration, years 3.0±3.3 3.8±3.7 3.8±3.5 2.5±3.1 0.10 BMI, kg/m2 24.1±3.1 23.8±3.7 24.8±2.9 23.9±3.0 0.39 Ever-smoker 18 5 5 18 0.57 RF positive, n (%) 111 (88.8) 19 (90.5) 22 (84.6) 70 (89.7) 0.72 Anti-CCP positive, n (%) 119 (95.2) 20 (95.2) 25 (96.2) 74 (94.9) 1.00 Arthritis activity DAS28-ESR 4.0 ± 1.4 4.1 ± 1.1 4.3 ± 1.8 3.8 ± 1.4 0.60 * DAS28-CRP 3.1 ± 1.4 3.2 ± 1.2 3.4 ± 1.6 3.0 ± 1.4 0.76 * HAQ-DI 0.70 ± 0.76 0.64 ± 0.49 0.82 ± 0.82 0.67 ± 0.80 0.28 * Pulmonary function test FVC, ml 2522.5 ± 765.4 2406.2 ± 772.6 2617.3 ± 965.2 2522.2 ± 692.3 0.65 FVC, % of pred. 84.6 ± 16.9 80.9 ± 17.7 86.12 ± 17.82 85.08 ± 16.5 0.53 FEV1, % of pred. 92.4 ± 21.4 92.0 ± 24.8 90.6 ± 22.1 93.0 ± 20.4 0.88 DLco, % of pred. 71.5 ± 19.7 72.3 ± 26.7 69.1 ± 16.4 72.0 ± 18.7 0.80 Figure 1. Acknowledgements: This research was supported by Bristol Myers Squibb Inc. Disclosure of Interests: Sung Hae Chang: None declared, Ji Sung Lee: None declared, Jeong Seok Lee: None declared, Chan Ho Park: None declared, Min Uk Kim: None declared, You-Jung Ha: None declared, Eun Ha Kang: None declared, Yeon Ah Lee: None declared, Yongbeom Park: None declared, Jung-Yoon Choe: None declared, Eun Young Lee Grant/research support from: Bristol Myers Squibb Inc.