Tocilizumab therapy in rheumatoid arthritis with interstitial lung disease: a multicentre retrospective study.

Andreina Manfredi,Eugenio Arrigoni,Luca Petricca,Marcello Govoni,Stefania Cerri,Giulia Cassone,Elisa Gremese,Carlo Salvarani,Florenzo Iannone,Marco Sebastiani,Giovanni Della Casa,Federica Furini,Vincenzo Venerito,Fabiola Atzeni

doi:10.1111/imj.14670

Abstract

Interstitial lung disease (ILD) is the most severe extra-articular manifestation of rheumatoid arthritis (RA). Although it is responsible of 10-20% of all RA mortality, no controlled studies are available for the treatment of RA-ILD and its therapeutic approach is still debated. To analyse the evolution of ILD in a population of RA patients treated with tocilizumab (TCZ). In this national multicentre study, we retrospectively collected patients with RA-ILD treated with at least one dose of TCZ. For each patient, disease activity and serological data were evaluated. Moreover, we analysed the evolution of high-resolution computed tomography (HRCT) and pulmonary function tests, including forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO). Twenty-eight RA-ILD patients were identified (females/males 18/10, mean age 61.6 years), with a mean follow up for TCZ therapy of 30 months. At the end of follow up, FVC remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%). DLCO remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%), even though in 3 patients DLCO and FVC showed an opposite trend. HRCT remained stable in the majority (25) of cases, worsened in two patients with a usual interstitial pneumonia pattern and improved in only one case with a non-specific interstitial pneumonia pattern. The management of RA-ILD patients remains a critical unmet need. TCZ demonstrated a good safety profile in patients with RA-ILD and a potential effect on the stabilisation of lung involvement.

Highlights

Rheumatoid arthritis (RA) is a chronic inflammatory disease, characterized by synovial joint swelling and tenderness, with progressive disability and joint destruction[1]
Twenty-three patients taken TCZ as monotherapy, while in 5 patients TCZ was associated to MTX; on the other hand, 20 patients were treated with a low dose of prednisone (5 mg daily or equivalent)
Curtis et al found no significant differences in the risk of Interstitial lung disease (ILD) incidence and its related complications between patients exposed to tocilizumab, rituximab, or abatacept compared with tumour necrosis factor inhibitors (TNFi) therapies[32]

Summary

Introduction

Rheumatoid arthritis (RA) is a chronic inflammatory disease, characterized by synovial joint swelling and tenderness, with progressive disability and joint destruction[1]. About 10% of the RA population develops a clinically significant ILD that is responsible for decreased quality of life and progressive chronic disability, and of 10-20% of all mortality associated to the disease, with a mean survival of 5-8 years[3,4,5,6]. The majority of conventional and biologic diseases modifying anti-rheumatic drugs (DMARDs) have been associated to the development or progression of ILD9-10 For these reasons, since no controlled studies are available, the therapeutic approach to RA-ILD is still debated and often empirical[7, 11,12,13]. Interstitial lung disease (ILD) is the most severe extra-articular manifestation of rheumatoid arthritis (RA) It is responsible of 10-20% of all RA mortality, no controlled studies are available for the treatment of RA-ILD and its therapeutic approach is still debated

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