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

Abstract

Background: Treatment of rheumatoid arthritis (RA)-related interstitial lung disease (ILD) is challenging, and many conventional and biologic disease-modifying anti-rheumatic drugs (DMARDs) have been associated with ILD development or progression. The aim of this multicentric retrospective study was to analyze the evolution of ILD in Italian RA-ILD patients treated with abatacept (ABA). Methods: All RA-ILD patients treated with ABA for at least six months were retrospectively evaluated. Serology, previous and concurrent therapies, chest high-resolution computer tomography (HRCT), forced vital capacity (FVC), and lung diffusion of carbon monoxide (CO, DLCO) were collected. Results: Forty-four patients were included; HRCT, FVC, and DLCO were analyzed at baseline, at one year, and at the end of follow-up. A remission or a low disease activity of RA was reached in 41/44 patients. Overall, FVC and DLCO remained stable or increased in 86.1% and 91.7% of patients, respectively, while HRCT was stable or improved in 81.4% of them. Previous and concurrent treatments, in particular, methotrexate, serology, age, sex, joint and lung disease duration were not associated with the outcome at univariate analysis. Conclusion: The management of RA-ILD patients remains a critical unmet medical need. Waiting for prospective controlled studies, ABA has shown a good safety profile in our cohort of Italian RA-ILD patients.

Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Lights and Shadows

“…FVC and DLCO remained stable or increased in 86.1% and 91.7% of patients, respectively, while HRCT was stable or improved in 81.4% of them. Previous and concurrent treatments, serology, age, sex, joint and lung disease duration were not associated with the outcome at univariate analysis [140].…”

“…Of interest, a preliminary small clinical trial is ongoing to assess the feasibility of a larger controlled study to evaluate the safety of ABA in RA-ILD (APRIL study, NCT03084419) ( Table 5 and Figure 2). [135] case report 1 Mera-Varela A, 2014 [134] case series 4 Nakashita T, 2014 [109] retrospective review 3 Nakashita T, 2016 [137] retrospective study 16 Ye W, 2017 [136] case report 1 Fernández-Díaz C, 2018 [138] retrospective study 63 Mochizuki T, 2019 [139] retrospective study 55 Cassone G, 2020 [140] retrospective study 44 Other articles * Kurata I, 2019 [131] retrospective study 12…”

Efficacy and safety of mycophenolate mofetil in the treatment of rheumatic disease-related interstitial lung disease: a narrative review

“…The use of abatacept, tocilizumab, and Jak inhibitors for RD-ILD has also been proposed in anecdotal reports. 37 , 38 , 155 – 157 …”

Immunmodulation bei autoimmunen interstitiellen Lungenerkrankungen

“…Bei 17% der Patienten wurde Abatacept aufgrund unerwünschter Ereignisse abgebrochen, darunter 3 Patienten mit schwerwiegenden Infektionen. Eine aktuelle retro­spektive Kohortenstudie mit 44 Patienten mit RA-ILD ergab vergleichbare positive Effekten auf die Lungenfunktion ohne schwerwiegende unerwünschte Ereignisse [105]. Derzeit läuft die Rekrutierung für 2 prospektive Studien zu Abatacept: In der APRIL-Studie (NCT03084419) soll in einem nicht verblindeten, 1-armigen Setting bei Patienten mit RA-ILD der Verlauf der Lungenfunktion untersucht werden, um als Machbarkeitsstudie die Grundlage für eine größer angelegte Studie zu bilden.…”