POS1414 RHEUMATOID ARTHRITIS AND INTERSTITIAL LUNG DISEASE: PREVALENCE AND DRUG PRESCRIPTIONS IN GERMAN CLAIMS DATA
Authors: K. Albrecht, A. Strangfeld, U. Marschall, J. Callhoff
Journal: Annals of the Rheumatic Diseases (2021)

Background: Persons with rheumatoid arthritis (RA) have an increased risk of interstitial lung disease (ILD). ILD is a serious extraarticular manifestation in RA with a significantly increased mortality but without evidence-based drug therapy (1). Objectives: The aim of this analysis was to investigate the frequency of ILD diagnosis in RA using claims data and to identify the medications prescribed. Methods: Data from a large German statutory health insurance fund were used to identify persons with one inpatient or two outpatient diagnoses of RA (ICD-10: M05, M06) and ILD (J84.1, J84.8, J84.9 and M05.1+J99.0) in 2019. Specialist care by rheumatologists and/or pulmonologists was identified using physician specialty numbers. Drug prescriptions of glucocorticoids, conventional synthetic disease modifying antirheumatic drugs (csDMARDs: methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, mycophenolate), biologic (b) DMARDs (abatacept, rituximab, TNF inhibitors, tocilizumab) or targeted synthetic (ts) DMARDs (tofacitinib) were identified by ATC codes. Prescriptions were included if a person received at least one prescription of the respective drug in 2019. Results: Among 7,479,000 persons over 18 years of age and insured in 2019 a total of 2.0% (n=148,000) had a diagnosis of RA and 1.1% (n=1,600) of those had an additional diagnosis of ILD. The majority of persons with RA+ILD diagnosis was older than 70 years (59%), mean age was 72 years, 68% were female and 41% had a diagnosis of serpositive RA (M05). 4 out of 5 patients were in rheumatologist or pulmonologist care (36% both, 22% only rheumatologist, 22% only pulmonologist). In total, 67% received glucocorticoids, 49% csDMARDs and 19% bDMARDs and 1.8% tofacitinib. TNF inhibitors were the most frequently prescribed bDMARDs followed by abatacept and tocilizumab. Persons without specialized care received considerably less DMARD therapy (Table 1). Nintedanib was prescribed to 14 patients, pirfenidon to 10 patients, all of them were in specialist care. Table 1. Demographics and treatment of persons with RA and ILD diagnosis, numbers are percentages unless indicated otherwise. Variable Not treated by rheumatologist or pulmonologist Treated by rheumatologist and/or pulmonologist All N (%) 326 (20%) 1274 (80%) 1,600 (100%) Age, mean years (std) 75 (10) 72 (10) 72 (10) &lt;70 years 35 43 41 70 to 80 years 31 39 37 &gt;80 years 35 18 22 Female sex 67 69 68 Glucocorticoids 49 72 67 csDMARDs 24 56 49 MTX 13 30 27 Leflunomide 4.9 10 8.9 (Hydroxy-)chloroquine 2.8 9.0 7.8 Mycophenolate 1.2 2.2 2.0 Sulfasalazine 2.1 3.8 3.4 bDMARDs 7 22 19 TNF-alpha Inhibitors 3.4 9.0 7.9 Abatacept 2.1 5.6 4.9 Tocilizumab 1.2 3.6 3.1 Rituximab 0.9 2.9 2.5 Tofacitinib 1.5 1.9 1.8 Conclusion: ILD was diagnosed in one of 100 persons with RA diagnosis. Specialist care is necessary to provide disease-specific therapies. While methotrexate is the most commonly used DMARD, the bDMARD prescription is heterogeneous. References: [1]Hyldgaard C, Ellingsen T, Hilberg O, Bendstrup E. Rheumatoid Arthritis-Associated Interstitial Lung Disease: Clinical Characteristics and Predictors of Mortality. Respiration. 2019;98(5):455-460. Acknowledgements: The study was supported by the German Federal Ministry of Education and Research within the network TARISMA [01EC1902A]. Disclosure of Interests: Katinka Albrecht: None declared, Anja Strangfeld: None declared, Ursula Marschall Employee of: Employee of the BARMER statutory health insurance fund, Johanna Callhoff: None declared