Progressive interstitial lung disease associated with rheumatoid arthritis and abatacept: data from a multicentre cohort of 526 patients

OBJECTIVE: To identify clinical and therapeutic predictors of interstitial lung disease (ILD) progression in patients with RA treated with abatacept (ABA) in clinical practice. METHODS: National multicentre study including 343 RA-associated interstitial lung disease patients from a national cohort of 526 individuals treated with ABA, all of them with serial pulmonary function tests available. Progressive ILD was defined as an absolute decline in forced vital capacity ≥10% or a relative decline of 5-9% combined with clinical progression (modified Medical Research Council Dyspnea Scale [mMRC]) and/or radiological progression (high-resolution computed tomography) over 24 months after starting ABA. A comparative and multivariable analysis was performed to identify factors associated with ILD progression. RESULTS: Progressive ILD occurred in 80 patients (23.3%), while 263 (76.7%) showed a stable or improved pulmonary functional course. Baseline characteristics were comparable between groups, except for higher dyspnoea scores and lower prior exposure to MTX (63% vs 76%; p = 0.02) and tocilizumab (4 vs 34; p = 0.048) among progressive cases. Multivariable analysis showed that prior treatment with MTX had a protective role (OR = 0.453), while previous golimumab exposure (OR = 10.009) and higher DAS28-ESR values (OR = 1.284) increased the risk of ILD progression. Interestingly, no significant differences were observed according to the ILD radiologic pattern or time from ABA initiation. CONCLUSIONS: Despite ABA therapy, progressive ILD occurred in nearly one-quarter of RA patients. ABA showed good tolerability and maintained pulmonary and rheumatologic stability in most cases. However, prior treatments and joint disease activity may help to predict the risk of ILD progression.