Baricitinib in rheumatoid arthritis-interstitial lung disease: national multicenter study of 72 patients and literature review

Abstract

Objective: To assess the effectiveness and safety of baricitinib (BARI) in Rheumatoid Arthritis-interstitial lung disease (RA-ILD) in clinical practice.

Methods: : National multicentre retrospective study of 72 RA-ILD patients treated with BARI. We analyzed the following outcomes at baseline and at 3, 6, 12, 18, 24 months, and last follow-up: a) dyspnea (modified Medical Research Council scale), b) forced vital capacity (FVC), c) diffusing capacity of the lungs for carbon monoxide (DLCO), d) chest high resolution computed tomography (HRCT), e) arthritis activity (DAS28-ESR), and f) corticosteroid-sparing effect. Additionally, we analyzed safety data and performed a literature review up to now.

Results: We included 72 patients (52 women; mean age 68 ± 10 years). All patients had received disease-modifying antirheumatic drugs (DMARDs). Median ILD duration up to BARI initiation was of 25 [13-63] months. Most frequent ILD patterns were usual interstitial pneumonia (n = 33; 49%) and non-specific interstitial pneumonia (n = 22; 32%). BARI was used in monotherapy in 43 (60%) patients and combined with conventional DMARDs in 29 (40%). Mean baseline values of FVC and DLCO (% pred.) were 86 ± 28 and 69 ± 20, respectively. After a median [IQR] follow-up of 32 [13-65] months dyspnea, FVC, DLCO, HRCT improved/stabilized in 90%, 88%, 65%, 72%, respectively. Mean DAS28-ESR improved from 4.29-2.99. and median prednisone dose was reduced from 5 to 2.5 mg/day. Relevant adverse events were uncommon.

Conclusion: BARI may be a useful and safe alternative in both pulmonary and joint disease in RA-ILD patients, even in refractory cases.

Keywords: JAK inhibitors; baricitinib; interstitial lung disease; rheumatoid arthritis.