Abatacept in usual and in non-specific interstitial pneumonia associated with rheumatoid arthritis.

To compare the effectiveness of abatacept (ABA) in Rheumatoid Arthritis-associated Interstitial Lung Disease (RA-ILD) according to the radiological patterns of usual (UIP) or non-specific interstitial pneumonia (NSIP). From an observational longitudinal multicentre study of 263 RA-ILD patients treated with ABA, those with UIP or NSIP were selected. Lung function, chest high resolution computerised tomography (HRCT) and dyspnoea were recorded and compared in both groups from baseline to the end of follow-up (progression definitions: improvement or worsening >10% of FVC or DLCO, changes in HRCT extension and 1-point change in the mMRC scale, respectively). Differences between final and baseline visits were calculated as the average difference (95% CI) through mixed effects models regression. We studied 190 patients with UIP (n=106) and NSIP (n=84). General features were similar in both groups except for older age, positive rheumatoid factor, and previous sulfasalazine therapy, which were more frequent in patients with UIP. ILD duration up to ABA initiation was relatively short: median 16 [4-50] and 11 [2-36] months (p=0.36) in UIP and NSIP, respectively. Mean baseline FVC and DLCO were 82% and 63% in UIP and 89% and 65% in NSIP, respectively. Both parameters remained stable during 24 months with ABA. HRCT lesions and dyspnoea improved/stabilized in 73.1% and 90.5% and 72.9% and 94.6% of UIP and NSIP patterns, respectively. ABA seems equally effective in stabilizing dyspnoea, lung function and radiological impairment in both UIP and NSIP patterns of RA-ILD. Early administration of ABA may prevent RA-ILD progression, regardless of the radiological pattern.

Atienza-Mateo B ，Fernández-Díaz C ，Vicente-Rabaneda EF ，Melero-González RB ，Ortiz-Sanjuán F ，Casafont-Solé I ，Rodríguez-García SC ，Ferraz-Amaro I ，Castañeda S ，Blanco R ，Spanish Collaborative Group of Abatacept in 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 ... -  《-》

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 ... -  《-》

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 ... -  《-》

High resolution computed tomography pattern of usual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease: Relationship to survival.

Interstitial lung disease is a common extra-articular manifestation of rheumatoid arthritis (RA-ILD) and is associated with significant morbidity and mortality. However, limited data exist regarding predictors of mortality. We sought to examine the prognostic value of the high-resolution computed tomography (HRCT) patterns in patients with RA-ILD. RA-ILD patients with HRCT patterns of usual interstitial pneumonia (UIP) or nonspecific interstitial pneumonia (NSIP) were identified among a longitudinal cohort of individuals evaluated at National Jewish Health. A total of 158 subjects were included in the study. For each subject, the earliest available HRCT was reviewed independently by two expert thoracic radiologists blinded to clinical data. HRCT patterns were classified as demonstrating definite UIP, possible UIP, or NSIP. Kaplan-Meier curves were generated and survival was compared among the three patterns using a log rank test for trend. One hundred subjects (63%) had HRCT findings classified as definite UIP, 23 (15%) as possible UIP and 35 (22%) as NSIP. No difference in survival was seen between subjects with definite UIP versus those with possible UIP. The combined group of subjects with either definite- or possible UIP had significantly worse survival than those with NSIP (log-rank p = 0.03). In patients with RA-ILD, patients with either definite UIP or possible UIP have equally poor survival when compared to those with an NSIP pattern.

Yunt ZX ，Chung JH ，Hobbs S ，Fernandez-Perez ER ，Olson AL ，Huie TJ ，Keith RC ，Janssen WJ ，Goldstein BL ，Lynch DA ，Brown KK ，Swigris JJ ，Solomon JJ ... -  《-》