ABATACEPT IN USUAL AND IN NON-SPECIFIC INTERSTITIAL PNEUMONIA ASSOCIATED TO RHEUMATOID ARTHRITIS. NATIONAL MULTICENTER STUDY OF 190 PATIENTS
B. Atienza-Mateo1, C. Fernández-Díaz2, S. Castañeda2, R. Melero3, F. Ortiz Sanjuan4, I. Casafont-Solé5, S. C. Rodriguez-García6, I. Ferraz-Amaro7, M. A. González-Gay1, R. Blanco1, on behalf of Members of the Spanish Collaborative Group of Abatacept in Interstitial Lung Disease Associated with 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).
1Hospital Universitario Marqués de Valdecilla, IDIVAL, Rheumatology, Santander, Spain
2Hospital Universitario La Princesa, Rheumatology, Madrid, Spain
3Complejo Hospitalario Universitario de Vigo, Rheumatology, Vigo, Spain
4Hospital Universitario La Fe, Rheumatology, Valencia, Spain
5Hospital Universitario Germans Trias i Pujol, Rheumatology, Barcelona, Spain
6Hospital Universitario Clinic, Rheumatology, Barcelona, Spain
7Hospital Universitario de Canarias, Rheumatology, Santa Cruz de Tenerife, Spain
Background: Interstitial lung disease (ILD) is a severe complication of Rheumatoid Arthritis (RA). Usual interstitial pneumonia (UIP) is considered to be more frequent and severe in RA than non-specific interstitial pneumonia (NSIP). Abatacept (ABA) and Rituximab have demonstrated efficacy in RA-ILD
[1-3].
Objectives: To compare the efficacy of ABA in RA-ILD patients according to radiological patterns of UIP or NSIP.
Methods: From an observational multicenter study of 263 RA-ILD patients treated with ABA, we selected those with UIP or NSIP
[2].
We analyzed in the 2 groups from baseline up to 24 months the following outcomes:
a
) Forced Vital Capacity (FVC),
b
) Carbon monoxide diffusing capacity (DLCO),
c
) Chest High Resolution Computed Tomography (HRCT), and
d
) dyspnea. Differences between final follow-up and basal visit were calculated as the average difference and 95% Confidence Interval (95% CI). Multivariable linear regression was used to assess the differences between the 2 groups.
Results: We studied 190 patients with UIP (n=106) and NSIP (n=84). Patients with UIP were older, had more positivity for rheumatoid factor and had received more sulfasalazine (
Table 1
). ILD duration up to ABA initiation was relatively short in both groups, with a median [IQR] of 16 [4-50] and 11 [2-36] months in UIP and NSIP patterns, respectively. Mean baseline values of FVC and DLCO were > 80% and > 60%, respectively, in the 2 groups, with a lower FVC in UIP (82% vs 89% in NSIP, p<0.05). The evolution of FVC and DLCO is shown in
Figure 1
. Both parameters remained stable during 24 months of ABA therapy. Available chest HRCT images improved/ stabilized in 73.1% and 72.9% of UIP and NSIP patterns, respectively. With multivariable linear regression analysis, no differences were found in the changes of FVC, DLCO, or HRCT images. Stabilization or improvement of dyspnea was found in 91% and 95% of UIP and NSIP patterns, respectively.
Conclusion: ABA seems to be equally effective in stabilizing of DLCO, FVC and HRCT in UIP and NSIP in RA-ILD. Our results suggest that an early administration of ABA in ILD, before significant structural lung damage development, may be preferable to prevent interstitial progression, regardless of the radiological pattern.
Evolution of pulmonary function tests in RA-ILD patients with UIP and NSIP patterns. FVC and DLCO are expressed as mean (95%CI) and compared between the 2 groups.
Acknowledgements: the Spanish Collaborative Group of Abatacept in Interstitial Lung Disease Associated with Rheumatoid Arthritis
Disclosure of Interests: Belén Atienza-Mateo: None declared, Carlos Fernández-Díaz Speakers bureau: Brystol Myers Squibb, Santos Castañeda: None declared, Rafael Melero: None declared, FRANCISCO ORTIZ SANJUAN: None declared, Ivette Casafont-Solé: None declared, Sebastián C Rodriguez-García: None declared, Iván Ferraz-Amaro: None declared, Miguel A González-Gay: None declared, Ricardo Blanco Speakers bureau: Brystol Myers Squibb
Citation: Ann Rheum Dis, volume 80, supplement 1, year 2021, page 531
