POS1559 THE CHARACTERISTICS OF THE PATIENTS UNDER NINTEDANIB TREATMENT DUE TO INTERSTITIAL LUNG DISEASES ASSOCIATED WITH CONNECTIVE TISSUE DISEASES

• Published in: Annals of the rheumatic diseases Vol. 82; no. Suppl 1; p. 1154
• Main Authors: Tekgoz, E, Colak, S, E Cimen Gunes, Ocal, N, Dogan, D, Tasci, C, Çinar, M, Yilmaz, S
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2023
• Subjects: Azathioprine; Comorbidity; Computed tomography; Connective tissue diseases; Cyclophosphamide; Diagnosis; Diarrhea; Fibrosis; Hypertension; Immunosuppressive agents; Intolerance; Lung diseases; Mycophenolate mofetil; Mycophenolic acid; Patients; Pneumonia; Respiratory function; Rheumatoid arthritis; Rituximab; Scleroderma; Sjogren's syndrome; Statistical analysis; Systemic sclerosis; Tomography
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2023-eular.6221

BackgroundNintedanib provides a decline in the reduction of forced vital capacity (FVC) in patients with progressing lung fibrosis.ObjectivesTo assess demographical, clinical, and radiological characteristics of the patients with connective tissue diseases (CTDs) associated interstitial lung disease (ILD), who were under nintedanib treatment.MethodsThis retrospective observational study was conducted with the patients who received nintedanib for progressing lung fibrosis associated with CTDs. The patients who had followed up between January 2020 and December 2022 included in the study. The demographical, clinical, and radiological data were obtained from patients’ files.ResultsTwenty-two (14.8%) patients (11 male/11 female) with CTD related ILD who had a mean age of 65.9 ±7.6 had received nintedanib. The median disease duration was 49.5 (35.8-101.8) months for CTD and 43 (26.3-95) months for ILD. Eighteen (81.8%) patients had a CTD diagnosis prior to an ILD diagnosis. The median duration for nintedanib treatment was 10.5 (7-14.8) months. Eight (36.4%) patients had Sjogren’s syndrome, 7 (31.8%) patients had systemic sclerosis, 5 (22.7%) patients had rheumatoid arthritis, and 2 (9.1%) patients had undifferentiated CTD. Ten (45.5%) patients had a history of smoking. Only one patient was using nintedanib 150 mg/day due to gastrointestinal intolerance. Hypertension was the most frequent comorbidity in 5 (22.2%) patients, and the second most frequent one was pulmonary hypertension in 3 (13.6%) patients. During 6 minutes walking test, 12 (55.5%) patients had desaturation. According to high-resolution computed tomography (HRCT) findings, 18 (81.8%) patients had usual interstitial pneumonia (UIP) pattern, and 4 (18.2%) patients had nonspecific interstitial pneumonia (NSIP) pattern. The most frequent parenchymal pattern was UIP (p<0.005). There was no mortality in the study group. Twelve (55.5%) patients had received at least one immunosuppressive treatment. Nintedanib was initiated due to the progression of fibrosis in HRCT in half of the patients or declined pulmonary function test results in the other half. All patients had worsening pulmonary symptoms. The mean FVC value of the patients at the beginning was 87±12.2 ml, and it was 89.3±14.8 ml at the 6th-month follow-up visit with no statistically significant difference (p=0.51). Four (66.7%) patients had stable findings, 2 (33.3%) patients had progression on HRCT, of whom had control HRCT under nintedanib treatment. Combined with nintedanib, cyclophosphamide (1 patient), rituximab (1 patients), azathioprine (3 patients), and mycophenolate mofetil (4 patients) were used. The most common side effect of nintedanib was diarrhea.Table 1.Demografic and clinical characteristics of the study groupNintedanib (n = 22)Gender, n (%)Female11 (50)Male11 (50)Age, a year65.9±7.6Disease duration for CTD, b month49.5 (35.8-101.8)Disease duration for ILD, b month43 (26.3-95)Duration of nintedanib treatment, b month10.5 (7-14.8)Sjogren’s syndrome, n (%)8 (36.4)Systemic sclerosis, n (%)7 (31.8)Rheumatoid arthritis, n (%)5 (22.7)Undifferentiated CTD, n (%)2 (9.1)Desaturation with 6 minutes walking test12 (55.5)Interstitial lung disease, n (%)UIP18 (81.8)NSIP4 (18.2)FVC ml, a initiation87±12.2FVC ml, a 6th month89.3±14.8CT findings, 6th month*Stabil, n (%)4 (66.7)Progression, n (%)2 (33.3)CTD= Connective tissue disease, ILD= Interstitial lung disease. NSIP= Nonspecific interstitial pneumonia, UIP= Usual interstitial pneumonia, FVC= Forced vital capacity, CT= Computerize tomographyaMean (SD). bmedian (Q1-Q3).ConclusionNintedanib is a promising agent for progressive lung fibrosis in patients with CTD-related ILD. Since physicians can safely combine it with immunosuppressive agents, more patients will benefit in the course of time. Prospective studies with longer follow-up, and larger samples are necessary to examine the role of nintedanib on lung fibrosis.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.