POS0855 EVOLUTION OF RHEUMATOID ARTHRITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE IN PATIENTS TREATED WITH JAK INHIBITORS: A MULTICENTER RETROSPECTIVE STUDY

• Published in: Annals of the rheumatic diseases Vol. 82; no. Suppl 1; p. 731
• Main Authors: Venerito, V, Manfredi, A, Carletto, A, Gentileschi, S, Atzeni, F, Guiducci, S, Lavista, M, La Corte, L, Pedrollo, E, Scardapane, A, Tomassini, C, Frediani, B, Salvarani, C, Iannone, F, Sebastiani, M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2023
• Subjects: Carbon monoxide; Clinical trials; Computed tomography; Evolution; Inflammation; Leflunomide; Lung diseases; Methotrexate; Patients; Respiratory function; Rheumatoid arthritis; Rheumatoid factor; Rheumatology; Rituximab; Tomography
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2023-eular.4122

BackgroundThe treatment to adopt when (Interstitial Lung Disease)ILD is detected in Rheumatoid Arthritis (RA) patients has always been a matter of debate. The management and treatment of RA-ILD is challenging because there is still little information available on this topic, and the main literature comes from observational studies. No clinical trials have been dedicated to this topic, however its consideration is increasing in guidelines. There is relatively limited data on the use of JAKi in patients with RA-associated ILD.ObjectivesThe aim of this multicenter retrospective study was to investigate the effectiveness and safety of the available JAKi in patients with RA-ILD.MethodsWe retrospectively analyzed patients with classified RA and RA-ILD undergoing JAKi in 6 Italian tertiary centres from April 2018 to June 2022. We included patients with at least 6 months of active therapy and one high-resolution chest tomography (HRCT) carried out within 3 months before the start of JAKi treatment. The HRCT was then compared to the most recent one carried out within 3 months before the last available follow-up appointment. We also kept track of the pulmonary function tests.ResultsWe included 43 patients with RA-ILD, 23 males (53.48%) with median age (interquartile range, IQR) of 68.87 (61.46-75.78) treated with JAKi. Clinical and disease characteristics have been reported in Table 1. The median follow-up was 19.1 months (11.03–34.43). The forced vital capacity remained stable in 22/28 (78.57%) patients, improved in 3/28 (10.71%) and worsened in 3/28 (10.71%). The diffusing Capacity of Lung for Carbon Monoxide showed a similar trend, remaining stable in 18/25 (72%) patients, improving in 2/25 (8%) and worsening in 5/25 (20%). The HRCT remained stable in 37/43 (86.05) cases, worsened in 4/43 (9.30%) and improved in the last 2 (4.65%) (Figure 1).ConclusionThis study seems to confirm that JAKi therapy might be a safe therapeutic option for patients with RA-ILD.References[1]Manfredi, A.; Cassone, G.; Luppi, F.; Atienza-Mateo, B.; Cavazza, A.; Sverzellati, N.; González-Gay, M.A.; Salvarani, C.; Sebastiani, M. Rheumatoid Arthritis Related Interstitial Lung Disease. Expert Rev Clin Immunol 2021, 17, 485–497, doi:10.1080/1744666X.2021.1905524.[2]Holroyd, C.R.; Seth, R.; Bukhari, M.; Malaviya, A.; Holmes, C.; Curtis, E.; Chan, C.; Yusuf, M.A.; Litwic, A.; Smolen, S.; et al. The British Society for Rheumatology Biologic DMARD Safety Guidelines in Inflammatory Arthritis. Rheumatology (Oxford) 2019, 58, e3–e42, doi:10.1093/rheumatology/key208.Table 1.Patient characteristics at Treatment BaselineAv Obs.BaselineAge, years, median (IQR)4368.87 (61.46-75.78)Male, n (%)4323 (53.48)Disease Duration, years, median (IQR)4312.66 (7.61)ILD duration, years, median (IQR)435.55 (5.13)Follow-up, months, median (IQR)4319.1 (14.92)Rheumatoid factor positivity, n (%)4338 (88.37)ACPA positivity, n (%)4335 (81.40)HRCT pattern, n (%)43UIP25 (58.14)NSIP5 (11.62)LIP2 (4.65)CPFE1 (2.33)Indeterminate10 (23.26)Baseline DLCO, mean (SD)2765.81 (16.92)Baseline FVC, mean (SD)3088.76 (24.03)Prescribed JAKi, n/%)43Baricitinib28 (65.12)Filgotinib3 (6.98)Tofacitinib9 (20.93)Upadacitinib3 (6.98)Use of DMARD before JAKi, n (%)43Methotrexate32 (74.41)Leflunomide3 (6.97)TNFalpha inhibitors19 (44.19)Rituximab12 (27.91)Abatacept16 (38.10)Tocilizumab13 (30.23)JAKi + Methotrexate, n (%)4316 (37.21)Glucorticoids n(%)4326 (60.47)Figure 1.Pulmonary Function Tests and High-Resolution Computed Tomography (HRCT) evolution. Upper Panel: ILD evolution at HRCT, Middle Panel:.Diffusing Capacity of Lung for Carbon Monoxide (DLCO). Lower Panel: Forced vital Capacity (FVC).[Figure omitted. See PDF]Acknowledgements:NIL.Disclosure of InterestsNone Declared.