Abatacept in monotherapy vs combined in interstitial lung disease of rheumatoid arthritis-multicentre study of 263 Caucasian patients.

To assess the efficacy and safety of abatacept (ABA) in monotherapy (ABAMONO) vs combined ABA [ABA plus MTX (ABAMTX) or ABA plus non-MTX conventional synthetic DMARDs (csDMARDs) (ABANON-MTX)] in RA patients with interstitial lung disease (ILD) (RA-ILD). This was a restrospective multicentre study of RA-ILD Caucasian patients treated with ABA. We analysed in the three groups (ABAMONO, ABAMTX, ABANON-MTX) the following outcome variables: (i) dyspnoea; (ii) forced vital capacity (FVC) and diffusion capacity of the lung for the carbon monoxide (DLCO); (iii) chest high-resolution CT (HRCT); (iv) DAS28-ESR; (v) CS-sparing effect; and (vi) ABA retention and side-effects. Differences between basal and final follow-up were evaluated. Multivariable linear regression was used to assess the differences between the three groups. We studied 263 RA-ILD patients (mean ± s.d. age 64.6 ± 10 years) [ABAMONO (n = 111), ABAMTX (n = 46) and ABANON-MTX (n = 106)]. At baseline, ABAMONO patients were older (67 ± 10 years) and took higher prednisone dose [10 (interquartile range 5-15) mg/day]. At that time, there were no statistically significant differences in sex, seropositivity, ILD patterns, FVC and DLCO, or disease duration. Following treatment, in all groups, most patients experienced stabilization or improvement in FVC, DLCO, dyspnoea and chest HRCT as well as improvement in DAS28-ESR. A statistically significant difference between basal and final follow-up was only found in CS-sparing effect in the group on combined ABA (ABAMTX or ABANON-MTX). However, in the multivariable analysis, there were no differences in any outcome variables between the three groups. In Caucasian individuals with RA-ILD, ABA in monotherapy or combined with MTX or with other conventional-DMARDs seems to be equally effective and safe. However, a CS-sparing effect is only observed with combined ABA.

Fernández-Díaz C ，Atienza-Mateo B ，Castañeda S ，Melero-Gonzalez RB ，Ortiz-SanJuan F ，Loricera J ，Casafont-Solé I ，Rodríguez-García S ，Aguilera-Cros C ，Villa-Blanco I ，Raya-Alvarez E ，Ojeda-García C ，Bonilla G ，López-Robles A ，Arboleya L ，Narváez J ，Cervantes E ，Maiz O ，Alvarez-Rivas MN ，Cabezas I ，Salgado E ，Hidalgo-Calleja C ，Fernández S ，Fernández JC ，Ferraz-Amaro I ，González-Gay MA ，Blanco R ，Spanish Collaborative Group of Interstitial Lung Disease Associated with Rheumatoid Arthritis ... -  《-》

Abatacept in interstitial lung disease associated with rheumatoid arthritis: national multicenter study of 263 patients.

To assess the efficacy of abatacept (ABA) in RA patients with interstitial lung disease (ILD) (RA-ILD). This was an observational, multicentre study of RA-ILD patients treated with at least one dose of ABA. ILD was diagnosed by high-resolution CT (HRCT). We analysed the following variables at baseline (ABA initiation), 12 months and at the end of the follow-up: Modified Medical Research Council (MMRC) scale (1-point change), forced vital capacity (FVC) or diffusion lung capacity for carbon monoxide (DLCO) (improvement or worsening ≥10%), HRCT, DAS on 28 joints evaluated using the ESR (DAS28ESR) and CS-sparing effect. We studied 263 RA-ILD patients [150 women/113 men; mean (s.d.) age 64.6 (10) years]. At baseline, they had a median duration of ILD of 1 (interquartile range 0.25-3.44) years, moderate or severe degree of dyspnoea (MMRC grade 2, 3 or 4) (40.3%), FVC (% of the predicted) mean (s.d.) 85.9 (21.8)%, DLCO (% of the predicted) 65.7 (18.3) and DAS28ESR 4.5 (1.5). The ILD patterns were: usual interstitial pneumonia (UIP) (40.3%), non-specific interstitial pneumonia (NSIP) (31.9%) and others (27.8%). ABA was prescribed at standard dose, i.v. (25.5%) or s.c. (74.5%). After a median follow-up of 12 (6-36) months the following variables did not show worsening: dyspnoea (MMRC) (91.9%); FVC (87.7%); DLCO (90.6%); and chest HRCT (76.6%). A significant improvement of DAS28ESR from 4.5 (1.5) to 3.1 (1.3) at the end of follow-up (P < 0.001) and a CS-sparing effect from a median 7.5 (5-10) to 5 (2.5-7.5) mg/day at the end of follow-up (P < 0.001) was also observed. ABA was withdrawn in 62 (23.6%) patients due to adverse events (n = 30), articular inefficacy (n = 27), ILD worsening (n = 3) and other causes (n = 2). ABA may be an effective and safe treatment for patients with RA-ILD.

Fernández-Díaz C ，Castañeda S ，Melero-González RB ，Ortiz-Sanjuán F ，Juan-Mas A ，Carrasco-Cubero C ，Casafont-Solé I ，Olivé A ，Rodríguez-Muguruza S ，Almodóvar-González R ，Castellanos-Moreira R ，Rodríguez-García SC ，Aguilera-Cros C ，Villa I ，Ordóñez-Palau S ，Raya-Alvarez E ，Morales-Garrido P ，Ojeda-García C ，Moreno-Ramos MJ ，Bonilla Hernán MG ，Hernández Rodríguez I ，López-Corbeto M ，Andreu JL ，Jiménez de Aberásturi JRD ，Ruibal-Escribano A ，Expósito-Molinero R ，Pérez-Sandoval T ，López-Robles AM ，Carreira-Delgado P ，Mena-Vázquez N ，Urruticoechea-Arana A ，Peralta-Ginés C ，Arboleya-Rodríguez L ，Narváez García FJ ，Palma-Sánchez D ，Cervantes Pérez EC ，Maiz-Alonso O ，Alvarez-Rivas MN ，Fernández-Melón J ，Vela Casasempere P ，Cabezas-Rodríguez I ，Castellvi-Barranco I ，González-Montagut C ，Blanco-Madrigal J ，Del Val-Del Amo N ，Fito MC ，Rodríguez-Gómez M ，Salgado-Pérez E ，García-Magallón B ，Hidalgo-Calleja C ，López-Sánchez R ，Fernández-Aguado S ，Fernández-López JC ，Castro-Oreiro S ，Serrano-García I ，García-Valle A ，Romero-Yuste S ，Expósito-Pérez L ，Pérez-Albadalejo L ，García-Aparicio A ，Quillis-Marti N ，Bernal-Vidal JA ，Loricera-García J ，Hernández JL ，González-Gay MA ，Blanco R ... -  《-》

Subcutaneous vs intravenous abatacept in rheumatoid arthritis-interstitial lung disease. National multicentre study of 397 patients.

Evidence on abatacept (ABA) utility for rheumatoid arthritis (RA) - associated interstitial lung disease (ILD) is growing. Clinical trials have shown equivalence in subcutaneous (SC) and intravenous (IV) administration of ABA for articular manifestations. However, this has not been studied in respiratory outcomes. To compare the effectiveness of ABA in RA-ILD patients according to the route of administration. National retrospective multicentre study of RA-ILD patients on treatment with ABA. They were divided into 2 groups: a) IV, and b) SC. The following outcomes were analysed from baseline to final follow-up using linear mixed models: a) forced vital capacity (FVC), b) diffusing capacity of the lungs for carbon monoxide (DLCO), c) chest high resolution computed tomography (HRCT), d) dyspnoea, e) RA activity, and f) sparing corticosteroids effect. A total of 397 patients were included (94 IV-ABA and 303 SC-ABA), median follow-up of 24 [10-48] months. After adjustment for possible confounders, FVC and DLCO remained stable during the first 24 months without differences between IV-ABA and SC-ABA (p = 0.6304 and 0.5337). Improvement/ stability of lung lesions in HRCT was observed in 67 % of patients (75 % IV-ABA, 64 % SC-ABA; p = 0.07). Dyspnoea stabilized/ improved in 84 % of patients (90 % IV-ABA, 82 % SC-ABA; p = 0.09). RA - disease activity improved in both groups. No statistically significant differences regarding any of the variables studied between the two groups were found. ABA was withdrawn in 87 patients (21.9 %), 45 % IV-ABA and 37 % SC-ABA (p = 0.29). ILD worsening and articular inefficacy were the most common reasons for ABA discontinuation. In patients with RA-ILD, ABA seems to be equally effective regardless of the route of administration.

López-Maraver M ，Serrano-Combarro A ，Atienza-Mateo B ，Del Val N ，Casafont-Solé I ，Melero-Gonzalez RB ，Pérez-Linaza A ，Calvo Gutiérrez J ，Mena-Vázquez N ，Vegas-Revenga N ，Domínguez-Casas L ，Loarce Martos J ，Peralta Ginés CA ，Diez Morrondo C ，Pérez Albaladejo L ，López Sánchez R ，Manzano Canabal MG ，Brandy-García AM ，López Viejo P ，Bonilla G ，Maiz-Alonso O ，Carrasco-Cubero C ，Garijo Bufort M ，Moreno M ，Urruticoechea-Arana A ，Ordóñez-Palau S ，González-Montagut C ，Giner Serret E ，De Dios Jiménez De Aberasturi JR ，Lozano Morillo F ，Vázquez Rodríguez T ，Carreira PE ，Blanco Madrigal JM ，Miguel Ibáñez B ，Rodríguez López M ，Fernández-Díaz C ，Loricera J ，Ferraz-Amaro I ，Ferrer-Pargada D ，Castañeda S ，Blanco R ，Spanish Collaborative Group of Abatacept in Interstitial Lung Disease Associated with Rheumatoid Arthritis ... -  《-》

Effect of abatacept versus conventional synthetic disease modifying anti-rheumatic drugs on rheumatoid arthritis-associated interstitial lung disease.

Lee KA ，Kim BY ，Kim SS ，Cheon YH ，Lee SI ，Kim SH ，Jung JH ，Kim GT ，Hur JW ，Lee MS ，Kim YS ，Hong SJ ，Park S ，Kim HS ... -  《-》

Abatacept in rheumatoid arthritis-associated interstitial lung disease: short-term outcomes and predictors of progression.

Interstitial lung disease in rheumatoid arthritis (RA-ILD) is an extra-articular involvement that impairs the prognosis and for which there is still no well-coded treatment. The aim of this study was to evaluate abatacept (ABA) effectiveness and safety in patients with RA-ILD. RA-ILD patients who started ABA treatment were consecutively enrolled. Chest high-resolution computed tomography (HRCT), clinical, laboratory and respiratory function variables were collected at baseline and after 18 months of ABA treatment. HRCT abnormalities were evaluated using a computer-aided method (CaM). ABA response was established based on the change in the percentage of fibrosis evaluated at HRCT-CaM, dividing patients into "worsened" (progression ≥ 15%), "improved" (reduction ≥ 15%), and "stable" (changes within the 15% range). The multivariate regression model was used to assess the associations between RA characteristics and ABA response. Forty-four patients (81% women, mean age 59.1 ± 8.0, mean disease duration of 7.5 ± 3.1 years) were studied. Five patients (11.4%) showed RA-ILD progression, 32 patients (72.6%) were considered stable, and 7 patients (16.0%) showed an RA-ILD improvement. The proportion of current smokers was significantly different between "worsened" patients, respect to those defined as "improved/stable" (p = 0.01). Current smoking habit (p = 0.005) and concomitant methotrexate treatment (p = 0.0078) were the two variables related to RA-ILD progression in multivariate regression analysis. Treatment with ABA is associated with a RA-ILD stability or improvement in the 88.6% of patients. Current smoking habit and concomitant treatment with methotrexate are the modifiable factors associated with RA-ILD worsening. Key Points • Abatacept plays a favourable role in the control of RA-ILD, with a significant worsening in only 11.4% of patients during a 18-month follow-up period. • The predictive variables related to RA-ILD progression during abatacept therapy are the concomitant treatment with methotrexate and current smoking habit.

Tardella M ，Di Carlo M ，Carotti M ，Giovagnoni A ，Salaffi F ... -  《-》