Effect of Biological Disease-modifying Anti-rheumatic Drugs on Airway and Interstitial Lung Disease in Patients with Rheumatoid Arthritis

Abstract

Objective Biological disease-modifying anti-rheumatic drugs (bDMARDs) represent an important advance in alleviating rheumatoid arthritis (RA), but their effect on rheumatic airway disease (AD) and interstitial lung disease (ILD) is still unclear. This study was performed to evaluate the association of the use of different bDMARDs with new-onset or worsening of RA-AD/ILD. Methods We performed a retrospective cohort study of RA patients who received bDMARDs and assessed their AD/ILD before and after drug initiation in our hospital over the past 10 years. We evaluated the serial changes in computed tomography (CT), classified patients according to AD/ILD progression, and analyzed associations between clinical characteristics and outcomes. Results We enrolled 49 patients. Thirty patients received tumor necrosis factor inhibitors (TNFis), 12 received abatacept (ABT), and the remaining 7 received tocilizumab (TCZ). Seventeen patients had ILD, 10 had AD, and 6 had both AD and ILD before the initiation of bDMARDs. New emergence or exacerbation of AD/ILD was observed in 18 patients after drug initiation, while the remaining 31 remained stable or improved. Multiple logistic regression analyses revealed that pre-existing AD was an independent risk factor against the emergence or exacerbation of RA-AD/ILD, and ABT use was a protective factor against it. Conclusion Our study showed that pre-existing RA-AD is associated with future worsening of RA-AD/ILD, and ABT over other bDMARDs was associated with a better prognosis. Future studies to confirm our results are needed.

Safety of Abatacept in Italian Patients with Rheumatoid Arthritis and Interstitial Lung Disease: A Multicenter Retrospective Study

“…Kurata et al recently found that ABA was an independent protective factor for RA-ILD exacerbation after the initiation of bDMARDs [31].…”

Diagnostic Challenges and Management Update in Rheumatoid Arthritis

“…Therefore, their protein structure predisposes patients to increased risk for infection, reactivation of latent tuberculosis, development of lupus-type reaction (mostly characterized by rashes, leukopenia, and thrombocytopenia) and vasculitis [107,109,111].…”

“…Pre-existing airway disease and interstitial lung disease have shown worsening symptoms and increased mortality after administering biological RA treatment [111].…”

“…Pre-existing airway disease and interstitial lung disease have shown worsening symptoms and increased mortality after administering biological RA treatment [110]. Neurological complications similar to multiple sclerosis symptoms and demyelinating disorders have also been associated with bDMARDs treatment and regular monitoring for new skin cancer is necessary regarding all patients receiving biologic agents [111]. Patients should not receive live vaccines during treatment, except for pneumococcal, influenza and hepatitis B which are killed vaccines [107,109,112].…”

“…Common adverse reactions include headaches, nasopharyngitis and upper respiratory tract infections, dizziness, back pain, hypertension, dyspepsia, urinary tract infections, rash. Several studies have shown that abatacept is associated with presents a better prognosis than other biologic agents in patients with RA and interstitial lung disease [111]. Precautions should nonetheless be taken in patients older than 65 years, due to the increased number of reported malignancy cases [107,108].…”