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POS0513 (2021)
ABATACEPT IN MONOTHERAPY VERSUS COMBINED IN INTERSTITIAL LUNG DISEASE OF RHEUMATOID ARTHRITIS. MULTICENTER STUDY OF 263 CAUCASIAN PATIENTS
C. Fernández-Díaz1, B. Atienza-Mateo1, S. Castañeda2, R. Melero3, F. Ortiz-Sanjuán4, I. Casafont-Solé5, J. Loricera1, S. C. Rodriguez-García6, I. Ferraz-Amaro7, M. A. González-Gay1, R. Blanco1, on behalf of Spanish Collaborative Group of Interstitial Lung Disease Associated to Rheumatoid Arthritis Members of the Spanish Collaborative Group of Interstitial Lung Disease Associated to Rheumatoid Arthritis: Clara Aguilera-Cros (H.U. Virgen del Rocío, Sevilla), Ignacio Villa (H. Sierrallana, Torrelavega), Enrique Raya-Alvarez (H.U. San Cecilio, Granada), Clara Ojeda-García (H.U. Virgen Macarena, Sevilla), María G. Bonilla Hernán (H.U. La Paz, Madrid), Ana M. López-Robles (H.U. Vall d’ Hebron, Barcelona), Luis Arboleya-Rodríguez (H.U. Central de Asturias, Asturias), Javier Narváez García (H.U. Bellvitge, Barcelona), Evelin C. Cervantes Pérez (H.U. de Santiago, Santiago de Compostela, A Coruña), OlgaMaiz-Alonso (H.U. Donostia, Gipuzkoa), María N. Alvarez-Rivas (H.U. Luca Augusti, Lugo), Iván Cabezas-Rodríguez (H.U. Río Hortega, Valladolid), Eva Salgado-Pérez (C.H.U. Ourense, Ourense), Cristina Hidalgo-Calleja (H.U. de Salamanca, Salamanca), Sabela Fernández-Aguado (H.U. Cabueñes, Asturias), Jesús C. Fernández-López (C.H.U. A Coruña), Alejandro Olivé, Samantha Rodríguez-Muguruza (H.U. GermansTrias i Pujol, Barcelona), Raquel Almodóvar-González (H.U. Fundación Alcorcón, Madrid), Carmen Carrasco-Cubero (C.H.U. Infanta Cristina, Badajoz), Antonio Juan-Mas (H. Son Llàtzer, Palma de Mallorca), Raúl Castellanos-Moreira (H.U. Clinic. Barcelona), Iñigo Hernández Rodríguez (C.H.U. de Vigo, Vigo), Neus Quillis-Marti (H. Vinalopo Elche), José A. Bernal-Vidal (H. Marina Baixa, Villajoyosa), Angel García-Aparicio (H. Virgen de la salud, Toledo), Sonia Castro-Oreiro (H.U. Joan XXIII, Tarragona), Julia Fernández-Melón (H. Son Espases, Palma de Mallorca), Paloma Vela Casasempere(H. U. Alicante, Alicante), María C. Fito, Carmen González-Montagut (C.U. Navarra, Navarra), Manuel Rodríguez-Gómez (C.H.U. Ourense, Ourense), Trinidad Pérez-Sandoval, Miriam Retuerto-Guerrero (H.U. León), Deseada Palma-Sánchez (H. Rafael Mendez, Lorca), José L. Andreu (H. U. Puerta del Hierro), Patricia Carreira-Delgado (H. 12 de Octubre, Madrid), Lorena Expósito-Pérez (H.U. de Canarias, Tenerife), Juan RD Jiménez- de Aberásturi, Ana Ruibal-Escribano (H.U. Txagorritxu, Araba), Ana Urruticoechea-Arana (H. Can Misses, Ibiza), Rosa Expósito-Molinero (H. Laredo, Laredo), Rubén López Sánchez (H. Negrín Las Palmas), Manuel J.Moreno-Ramos (H. Virgen de la Arrixaca, Murcia), Isabel Serrano-García (H. Puerta del Mar Cadiz), Blanca García-Magallón (H. San Jorge Huesca), José María Andreu Ubero (H. Virgen de las Nieves Granada), Natalia Mena-Vázquez (H.R.U Málaga), Iván Castellvi-Barranco (H.U. De la Santa Creu i Sant Pau, Barcelona), Carmen González-Montagut (H. U. Valladolid, Valladolid), Juan Blanco-Madrigal (H. Basurto, Bilbao), Pilar Morales-Garrido (H.U. San Cecilio, Granada), Cilia Peralta-Ginés (H. Lozano Blesa, Zaragoza), Mireia López-Corbeto (H.U. Vall d’ Hebron, Barcelona), Sergio Ordóñez-Palau (H. Lleida, Lleida), Andrea García-Valle (H. U Palencia), Susana Romero-Yuste (H.U. Pontevedra, Pontevedra).
1Marqués de Valdecilla University Hospital, Rheumatology, Santander, Spain
2Hospital de La Princesa, Rheumatology, Madrid, Spain
3Complejo Hospitalario Universitario de VIgo, Rheumatology, Vigo, Spain
4Hospital La Fe, Rheumatology, Valencia, Spain
5Hospital Germans Trias i Pujol, Rheumatology, Badalona, Spain
6Hospital Clínic, Rheumatology, Barcelona, Spain
7Hospital Universitario de Canarias, Rheumatology, San Cristóbal de La Laguna, Spain

Background: Interstitial lung disease (ILD) is a severe complication of RA. Abatacept (ABA) have demonstrated efficacy in RA-ILD [1,2], although combined treatment with MTX or others DMARDs remain controversial.


Objectives: To assess the efficacy and safety of ABA in monotherapy (ABA MONO ) versus combined-ABA, ABA plus MTX(ABA MTX ) or ABA plus other non-MTX DMARDs (ABA NON-MTX ), in RA-ILD.


Methods: Observational multicenter study of RA-ILD caucasian patients treated with ABA. We analyzed in three groups (ABA MONO , ABA MTX , ABA NON-MTX ) the following outcomes: a ) Dyspnea, b ) FVC and DLCO, c ) HRCT, d ) DAS28-ESR, e ) corticosteroid-sparing effect. Differences between basal and final follow-up were evaluated. Multivariable linear regression was used between the three groups.


Results: We studied 263 RA-ILD patients (mean age 64.6±10 years) [ABA MONO (n=111), ABA MTX (n=46) and ABA NON-MTX (n=106)]. At baseline, ABA MONO patients were older (67±10 years) and took higher prednisone dose (10 [IQR 5-15] mg/day). There was no statistically significant differences in sex, seropositivity, ILD patterns, FVC, DLCO or disease duration. In all groups, most patients experienced stabilization or improvement in FVC, DLCO, dyspnea, HRCT as well as improvement in DAS28-ESR. A statistically significant difference between basal and final follow-up was only found in corticosteroid-sparing effect in ABA MTX or ABA NON-MTX ( Figure 1 ). However, in the multivariable analysis, there were no differences in any outcome between the three groups( Table 1 ).

Effect in FVC, DLCO, dyspnea (mMRC) and HRCT pulmonary scan after abatacept.

ABA MONO N=111 ABA MTX N=46 ABA NON-MTX N=106 ABA MTX vs ABA MONO ABA NON-MTX vs ABA MONO
p p p p* Unadjusted Adjusted** Unadjusted Adjusted**
Follow-up, median [IQR] months 12 [6-36] 12 [6-36] 18[12-36] 0.40 0.67 0.17
Differences between basal and final follow-up
FVC, % -0.5 (-2.5, 1.5) 0.64 1.2(-0.6, 3.1) 0.17 -1.2 (-2.9, 0.5) 0.17 0.33 0.30 0.39 0.59 0.90
DLCO, % 1.8 (-0.7, 4.34) 0.16 0.5 (-3.8, 4.8) 0.82 -1.5 (-4.1, 1.1) 0.26 0.20 0.58 0.80 0.07 0.32
mMRC, n (%)
Worsening 5 (5) 3 (8) 5 (5) 0.83 0.47 0.99
Stable or improving 93 (95) 36 (92) 87 (95)
HRCT pulmonary scan, n (%)
Worsening 13 (28) 2 (11) 15 (25) 0.24 0.10 0.78
Stable or improving 34 (72) 19 (89) 44 (75)
DAS28-ESR -1.5 (-1.9, -1.0 ) 0.000 -1.2 (-1.8, -0.6 ) 0.000 -1.5 (-1.8, -1.2 ) 0.000 0.74 0.58 0.92
Prednisone, mg/day -3.8 (-8.3, 0.8) 0.10 -2.7 (-4.6, -0.8 ) 0.006 -4.8 (-6.3, -3.4 ) 0.000 0.69 0.67 0.65

Differences in DAS28-ESR, prednisone, FVC and DLCO are expressed as mean difference (95%CI) comparing final follow-up minus basal values.

*Differences between the 3 groups.

**Differences between ABA MTX vs. ABA MONO , and between ABA NON-MTX vs ABA MONO are adjusted for age, disease duration until abatacept treatment, and DAS28 and prednisone dose at baseline.

Abbreviations (DAS28-ESR: Disease activity score-erythrocyte sedimentation rate; DLCO: Carbon Monoxide Diffusing Capacity; HRCT: High resolution computed tomography; FVC: Forced vital capacity, mMRC: modified Medical Research Council scale


Conclusion: In caucasian individuals with RA-ILD, ABA MONO or ABA MTX or ABA NON-MTX seems to be equally effective and safe. However, a corticosteroid-sparing effect is only observed in combined-ABA.


REFERENCES:

[1]Fernández-Díaz C, et al. Abatacept in patients with rheumatoid arthritis and interstitial lung disease: A national multicenter study of 63 patients. Semin Arthritis Rheum. 2018 Aug;48(1):22-27. doi: 10.1016/j.semarthrit.2017.12.012.

[2]Fernández-Díaz C, et al. Abatacept in interstitial lung disease associated with rheumatoid arthritis: national multicenter study of 263 patients. Rheumatology (Oxford). 2020 Dec 1;59(12):3906-3916. doi: 10.1093/rheumatology/keaa621.


Acknowledgements: Spanish Collaborative Group of Interstitial Lung Disease Associated to Rheumatoid Arthritis


Disclosure of Interests: Carlos Fernández-Díaz Speakers bureau: Roche, bristol myers squibb, Belén Atienza-Mateo: None declared, Santos Castañeda: None declared, Rafael Melero: None declared, Francisco Ortiz-Sanjuán: None declared, Ivette Casafont-Solé: None declared, J. Loricera: None declared, Sebastián C Rodriguez-García: None declared, Iván Ferraz-Amaro: None declared, Miguel A González-Gay: None declared, Ricardo Blanco Speakers bureau: bristol myers squibb

Citation: Ann Rheum Dis, volume 80, supplement 1, year 2021, page 490
Session: Rheumatoid arthritis - comorbidity and clinical aspects (POSTERS only)