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Multicenter Study
. 2021 Dec 24;61(1):299-308.
doi: 10.1093/rheumatology/keab317.

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

Carlos Fernández-Díaz  1 , Belén Atienza-Mateo  1 , Santos Castañeda  2 , Rafael B Melero-Gonzalez  3 , Francisco Ortiz-SanJuan  4 , Javier Loricera  1 , Ivette Casafont-Solé  5 , Sebastián Rodríguez-García  6 , Clara Aguilera-Cros  7 , Ignacio Villa-Blanco  8 , Enrique Raya-Alvarez  9 , Clara Ojeda-García  10 , Gema Bonilla  11 , Alejandra López-Robles  12 , Luis Arboleya  13 , Javier Narváez  14 , Evelin Cervantes  15 , Olga Maiz  16 , María N Alvarez-Rivas  17 , Iván Cabezas  18 , Eva Salgado  19 , Cristina Hidalgo-Calleja  20 , Sabela Fernández  21 , Jesús C Fernández  22 , Ivan Ferraz-Amaro  23 , Miguel A González-Gay  1 , Ricardo Blanco  1 ; Spanish Collaborative Group of Interstitial Lung Disease Associated with Rheumatoid Arthritis
Affiliations
Multicenter Study

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

Carlos Fernández-Díaz et al. Rheumatology (Oxford). .

Abstract

Objective: 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).

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: abatacept; comorbidity; conventional disease-modifying antirheumatic drugs; high-resolution computed tomography; interstitial lung disease; methotrexate; rheumatoid arthritis.

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