POS0408 CONTROLLING DISEASE ACTIVITY WITH BIOLOGICAL DMARDS PREVENTS DEVELOPMENT/PROGRESSION OF INTERSTITIAL LUNG DISEASE IN RHEUMATOID ARTHRITIS
Authors: A. Tanaka, K. Kurasawa, A. Kikuchi, S. Komatsu, Y. Aizawa, A. Shimizu, Y. Yoshida, A. Hasegawa, T. Hiyama, T. Miyao, S. Arai, T. Owada, R. Maezawa, M. Arima, K. Ikeda
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Interstitial lung disease (ILD) is a serious organ involvement in rheumatoid arthritis (RA) that is associated with poor prognosis and outcomes. Current evidence for the effects of biological DMARDs (bDMARDs) on RA-ILD has been conflicting. We previously reported that switching from bDMARDs to targeted-synthetic DMARDs (tsDMARDs) suppresses the progression of ILD on CT as well as disease activity in patients with RA (EULAR 2023). However, whether this inhibition of ILD is tsDMARD-specific or via controlling disease activity of RA is unknown, as few studies have assessed the association between disease activity and ILD outcome by using CT images in RA patients treated with bDMARDs. <h3>Objectives:</h3> To clarify the association between disease activity and the development/progression of ILD on CT in RA patients treated with bDMARDs. <h3>Methods:</h3> We conducted a retrospective cohort study with consecutive RA patients from February 2004 to March 2019. We included patients who were treated with bDMARDs for more than 6 months and received chest CT scans before (baseline) and during (follow-up) the treatment. Disease activity of RA was assessed at follow-up using DAS28-ESR. We semi-quantitatively scored the extent of interstitial lung lesions in pre-defined 6 lung fields on chest CT: 0 (absent), 1 (&lt;25%), 2 (25–50%), and 3 (50%&lt;). We calculated the total ILD score for each patient by summing the ILD scores of all lung fields (0-18). Based on the total ILD scores at baseline and follow-up, the change of ILD was judged as either newly developed, progressed, no change, or improved. We also assessed the death after follow-up. <h3>Results:</h3> A total of 179 patients with RA were studied. 124 (69.3%) were female, mean age was 58.8 years, and median disease duration was 3.7 years. Anti-CCP antibody and rheumatoid factor were positive in 84.1% and 84.4% of the patients, respectively. Median DAS28-ESR at baseline was 4.25 and ILD was present in 62 patients (34.6%) at baseline. Median interval between baseline and follow-up was 3.0. At follow-up, 37 patients (20.6%) achieved remission/low disease activity (LDA group). The usages of MTX and TNF inhibitors were similar between the LDA and the non-LDA groups. However, glucocorticoids were used more frequently in the non-LDA group (76.8%) compared to the LDA group (56.5%) (p=0.004). ILD newly developed in 17 (9.5%), progressed in 22 (12.3%), was no change in 134 (74.9%), and improved 8 (4.5%). New development/progression of ILD occurred in 2/35 patients (5.7%) in the LDA group and in 37/132 (28.0%) in the non-LDA group (p=0.006) (Figure 1, left graph). In patients with pre-existing ILD at baseline, 2/15 patients (13.3%) in the LDA group and 20/47 (42.6%) in the non-LDA group had progression of ILD (p=0.04) (Figure 1, right graph). Logistic regression analyses demonstrated that the association of non-LDA with ILD progression was independent of glucocorticoid usage. Moreover, all 6 patients who died of respiratory failure were in the non-LDA group. <h3>Conclusion:</h3> Patients with RA who achieved LDA after receiving treatment with bDMARDs were less likely to develop or progress ILD, which indicates controlling RA disease activity is critical to prevent the development/progression of ILD. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Ayae Tanaka: None declared, Kazuhiro Kurasawa: None declared, Azusa Kikuchi: None declared, Sara Komatsu: None declared, Yuki Aizawa: None declared, Aya Shimizu: None declared, Yuhi Yoshida: None declared, Anna Hasegawa: None declared, Tomoka Hiyama: None declared, Tomoyuki Miyao: None declared, Satoko Arai: None declared, Takayoshi Owada: None declared, Reika Maezawa: None declared, Masafumi Arima: None declared, Kei Ikeda Eli Lilly, Abbvie, Eisai, Gilead, AstraZeneca, Asahi Kasei, Mitsubishi-Tanabe.