Pos0597 effects of Rituximab in Patients With Rheumatoid Arthritis-Related Interstitial Lung Disease: A Single-Centre Experience From Turkey

Abstract

Background:Rheumatoid arthritis-related interstitial lung disease (RA-ILD) is the most common type of lung involvement in rheumatoid arthritis (RA). The existence of RA-ILD is associated with worse survival. There is no mainstay treatment for RA-ILD. However, in recent studies, rituximab (RTX) seems to be effective in RA-ILD.Objectives:To determine the effects of RTX in patients with RA-ILD from a single-centre.Methods:In our biological treatment outpatient clinic, a retrospective study was conducted in patients with RA who were treated with RTX. Among them, patients with RA-ILD were analysed. For lung response to RTX, progression was defined as a decline of 10% ≥ in forced vital capacity (FVC) and/or a decline of 15% ≥ in diffusion capacity of carbon monoxide (DLCO). Computed tomography of the chest (chest-CT) were integrated to lung response so as to constitute missing data of pulmonary function tests (PFTs).Results:A total of 165 patients who are followed-up in our biological treatment outpatient clinic have been using RTX for their RA diagnosis. Among 165 patients, 26 (15.8%) patients with RA-ILD were initiated RTX. Five patients were diagnosed with RA-ILD while using RTX (incidence rate 3%). Patients‘ characteristics were demonstrated in table 1. Of 26 patients, the most commonly used concomitant disease-modifying antirheumatic drugs was leflunomide (46.2%) followed by mycophenolate mofetil (11.5), methotrexate (11.5%) and azathioprine (3.8%). Twenty-four (92.3%) patients used steroids. For the evaluation of lung response, 20 patients who had follow-up PFTs and/or chest-CT were compared. Median DLCO values for pre- and post RTX were 71.0% (60.0-77.0) and 63.0% (47.0-74.0), respectively (p= 0.061). Median pre and post-RTX FVC were 74.0% (61.0-99.0) and 84.0% (63.0-100.0), respectively (p= 0.28). After a median of 2.7 years, 11 (55.0%) patients had stable disease, 2 (10.0%) patients had regression of RA-ILD and 7 (35.0%) patients had progressive disease. Sex, age, seropositivity and radiographic patterns were not associated with progression. In total, 23 adverse events were detected in 11 (42.3%) patients. Five of them were serious infections requiring hospitalization, mostly pneumonia. Other adverse events were simple infections and surgeries such as arthroplasty. RTX was stopped in 4 (15.4%) patients due to infections secondary to hypogammaglobulinemia in 2, malignancy in 1 and allergic reaction in 1.Conclusion:RTX seems to achieve stabilization/improvement of RA-ILD with fewer adverse events. However, given that RA-ILD develops post-RTX, it is not a panacea; therefore, we need more effective treatment modalities in the case of RA-ILD.Table 1.Characteristics of 26 patients with RA-ILD treated with rituximabAge at first RTX infusion, median (IQR), years61.2 (57.1-65.1)RA disease duration at first RTX, median (IQR), years10.1 (4.3-29.7)ILD disease duration at first RTX, median (IQR), years1.9 (0.1-4.5)Age at RA diagnosis, median (IQR), years51.1 (40.0-60.6)Age at ILD diagnosis, median (IQR), years58.3 (53.9-63.3)Male patient, n (%)16 (61.5)RF positivity, n (%)25 (96.2)ACPA positivity, n (%)20 (90.9)CRP levels,mg/L, mean (SD)40.3 (58.9)ESR levels, mean (SD)37.7 (18.2)Smoking status, n (%)16 (64.0)Prior TNF inhibitor treatment, n (%)5 (19.2)DAS28 at first RTX infusion, mean (SD)5.3 (1.5)Radiographic pattern, n (%)UIP7 (26.9)NSIP8 (30.8)OP2 (7.7)Indeterminate8 (30.8)Others1 (3.8)Follow-up duration, median (IQR), years2.5 (1.2-3.7)RA-ILD= Rheumatoid arthritis-related interstitial lung disease, RTX= rituximab, RA= rheumatoid arthritis, RF= rheumatoid factor, ACPA= anti-citrullinated protein antibody, TNF= tumor necrosis factor, CRP= C-reactive protein, ESR= erythrocyte sedimentation rate, UIP= usual interstitial pneumonia, NSIP= non-specific interstitial pneumonia, OP= organizing pneumoniaDisclosure of Interests:None declared

Navigating the maze of treatment strategies for RA‐ILD: Insights and innovations for better patient outcomes

“…Rituximab is an anti‐CD20 monoclonal antibody and can play a function in the regulation of adaptive immunity by depletion of B cells. In clinical practice, rituximab is usually reserved for refractory or rapidly progressive disease 25 . Rituximab and CYC reached similar efficacy in the treatment of CTD‐ILD, including quality of life and preservation of lung function, in the RECITAL study 26 .…”