Effect of rituximab on the progression of rheumatoid arthritis–related interstitial lung disease: 10 years' experience at a single centre. (24th April 2017)

• Record Type: Journal Article
• Authors: Md Yusof, Md Yuzaiful; Kabia, Angela; Darby, Michael; Lettieri, Giovanni; Beirne, Paul; Vital, Edward M.; Dass, Shouvik; Emery, Paul
• Is Part Of: Rheumatology. Volume 56:Number 8(2017)
• Page Start: 1348
• Page End: 1357
• Publication Date: 2017-04-24
• Subjects: B cells -- biologic therapies -- immunosuppressant -- respiratory -- rheumatoid arthritis; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/kex072
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objective. To evaluate the effect of rituximab (RTX) in patients with RA-related interstitial lung disease (RA-ILD) and identify factors associated with outcome after treatment. Methods. An observational study of patients with RA-ILD was conducted from a cohort of RTX-treated RA patients in a single centre for >10 years. Progression was defined by any of the following: a decrease of pre-RTX forced vital capacity (FVC) >10% or diffusion capacity of carbon monoxide (DLCO) >15% predicted, worsening of the ILD score or death from progressive ILD. Results. Of 700 RA patients treated with RTX, 56 had RA-ILD (prevalence = 8%). After RTX, new ILD was diagnosed in 3/700 patients (incidence = 0.4%). Data for lung assessment were available for 44/56 patients. The median relative change pre- and post-RTX for FVC were −2.4% and +1.2% ( P = 0.025) and for DLCO were −4.4% and −1.3% ( P = 0.045). Post-RTX, 23/44 (52%) were stable and 7/44 (16%) had improved. Of the 14 (32%) with ILD that progressed, 9/56 (16%) were deaths due to progressive ILD. Factors associated with ILD progression were radiologic pattern of usual interstitial pneumonia, a previous history of lung progression and pre-RTX DLCO <46% predicted. Of those whose ILD progressed, 11/14 (79%) had severe ILD before RTX [median DLCO 42% predicted (interquartile range 41–49)]. Conclusion. In this cohort of patients where RTX was given for arthritis, most patients with ILD pre-RTX remained stable/improved after treatment over a prolonged follow-up period. Patients who deteriorated/died had the most severe ILD pre-RTX, suggesting the drug was not contributory. RTX appears to be an acceptable therapeutic choice for patients with RA-ILD and further studies are warranted.