Projects per year
Abstract
Objectives:
Guidelines cautioned prescribing of tumour necrosis factor inhibitors (TNFi) to patients with
rheumatoid arthritis and interstitial lung disease (RA-ILD) after reports of new or worsening of ILD.
Less is known about outcomes among RA-ILD patients who receive rituximab (RTX). This study
compares mortality in patients with RA-ILD who received RTX or TNFi as their first biologic.
Methods:
Participants with RA-ILD recruited to the British Society for Rheumatology Biologics Register for RA
were included. Death rates were calculated and risk comparisons were made using Cox regression.
Causes of death, including the frequency in which ILD was recorded on death certificates were
examined.
Results:
43 RTX and 309 TNFi patients were included. RTX recipients had shorter disease duration and less
disability. Death rates were 94.8 (95%CI:74.4-118.7) and 53.0 (22.9-104.6) per 1000 pyrs, respectively. The adjusted mortality risk was halved in the RTX cohort, but the difference was not
statistically significant (HR 0.53, 95%CI:0.26-1.10). ILD was the underlying cause of death in 1 of 7 RTX deaths (14%) and 12 of 76 TNFi deaths (16%).
Conclusions:
Patients with RA-ILD who received RTX had lower mortality rates compared to TNFi. Absence of information on ILD severity or subtype prevents conclusions of which drug represents the best
choice in patients with RA-ILD and active arthritis.
Guidelines cautioned prescribing of tumour necrosis factor inhibitors (TNFi) to patients with
rheumatoid arthritis and interstitial lung disease (RA-ILD) after reports of new or worsening of ILD.
Less is known about outcomes among RA-ILD patients who receive rituximab (RTX). This study
compares mortality in patients with RA-ILD who received RTX or TNFi as their first biologic.
Methods:
Participants with RA-ILD recruited to the British Society for Rheumatology Biologics Register for RA
were included. Death rates were calculated and risk comparisons were made using Cox regression.
Causes of death, including the frequency in which ILD was recorded on death certificates were
examined.
Results:
43 RTX and 309 TNFi patients were included. RTX recipients had shorter disease duration and less
disability. Death rates were 94.8 (95%CI:74.4-118.7) and 53.0 (22.9-104.6) per 1000 pyrs, respectively. The adjusted mortality risk was halved in the RTX cohort, but the difference was not
statistically significant (HR 0.53, 95%CI:0.26-1.10). ILD was the underlying cause of death in 1 of 7 RTX deaths (14%) and 12 of 76 TNFi deaths (16%).
Conclusions:
Patients with RA-ILD who received RTX had lower mortality rates compared to TNFi. Absence of information on ILD severity or subtype prevents conclusions of which drug represents the best
choice in patients with RA-ILD and active arthritis.
| Original language | English |
|---|---|
| Article number | e000473 |
| Journal | RMD Open |
| Volume | 3 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 1 Jul 2017 |
Keywords
- Rheumatoid arthritis
- DMARDs (biologic)
- Anti-TNF
- pulmonary fibrosis
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British Society for Rheumatology Rheumatoid Arthritis Register (BSRBR-RA)
Hyrich, K. (PI), Watson, K. (Support team), Mowbray, K. (Support team), Kearsley-Fleet, L. (CoI), Lunt, M. (CoI) & Verstappen, S. (CoI)
Project: Research
-
Arthritis Research UK Centre of Excellence in Epidemiology.
Symmons, D. (PI), Bruce, I. (CoI), Dixon, W. (CoI), Felson, D. (CoI), Hyrich, K. (CoI), Lunt, M. (CoI), Mcbeth, J. (CoI), O'Neill, T. (CoI) & Verstappen, S. (CoI)
1/08/13 → 31/07/18
Project: Research