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

Abstract

Objective: The objective of this study was to assess the effectiveness and safety of baricitinib (BARI) in interstitial lung disease associated with RA (RA-ILD) in clinical practice.

Methods: : This was a national multicentre retrospective study of 72 RA-ILD patients treated with BARI. We analysed the following outcomes at baseline and at 3, 6, 12, 18 and 24 months, and at last follow-up: (i) dyspnea (modified Medical Research Council scale), (ii) forced vital capacity (FVC), (iii) diffusing capacity of the lungs for carbon monoxide (DLCO), (iv) chest high-resolution CT (HRCT), (v) arthritis activity (DAS28-ESR), and (vi) CS-sparing effect. Additionally, we analysed the safety data and performed a literature review up to December 2023.

Results: We included 72 patients (52 women; mean (s.d.) age 68 (10) years). All patients had received DMARDs. The median [interquartile range (IQR)] ILD duration up to BARI initiation was 25 [13-63] months. The 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 synthetic DMARDs in 29 (40%). Mean (s.d.) baseline values of FVC and DLCO (% predicted) were 86 (28) and 69 (20), respectively. After a median [IQR] follow-up of 32 [13-65] months, dyspnea, FVC, DLCO and HRCT improved or stabilized in 90%, 88%, 65% and 72%, respectively. The mean DAS28-ESR improved from 4.29 to 2.99, and the 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.