Korean J Intern Med.  2024 Sep;39(5):855-864. 10.3904/kjim.2023.207.

Effect of abatacept versus csDMARDs on rheumatoid arthritis-associated interstitial lung disease

• Lee KA
• Kim BY
• Kim SS
• Cheon YH
• Lee SI
• Kim SH
• Jung JH
• Kim GT
• Hur JW
• Lee MS
• Kim YS
• Hong SJ
• Park S
• Kim HS

• KMID: 2558776
• DOI: http://doi.org/10.3904/kjim.2023.207

Abstract

Background/Aims
To compare the effects of abatacept and conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) on the progression and development of rheumatoid arthritis-associated interstitial lung disease (RA-ILD).
Methods
This multi-center retrospective study included RA patients receiving abatacept or csDMARDs who underwent at least two pulmonary function tests and/or chest high-resolution computed tomography (HRCT). We compared the following outcomes between the groups: progression of RA-ILD, development of new ILD in RA patients without ILD at baseline, 28-joint Disease Activity Score with the erythrocyte sedimentation rate (DAS28-ESR), and safety. Longitudinal changes were compared between the groups by using a generalized estimating equation.
Results
The study included 123 patients who were treated with abatacept (n = 59) or csDMARDs (n = 64). Nineteen (32.2%) and 38 (59.4%) patients treated with abatacept and csDMARDs, respectively, presented with RA-ILD at baseline. Newly developed ILD occurred in one patient receiving triple csDMARDs for 32 months. Among patients with RA-ILD at baseline, ILD progressed in 21.1% of cases treated with abatacept and 34.2% of cases treated with csDMARDs during a median 21-month follow-up. Longitudinal changes in forced vital capacity and diffusing capacity for carbon monoxide were comparable between the two groups. However, the abatacept group showed a more significant decrease in DAS28-ESR and glucocorticoid doses than csDMARDs group during the follow-up. The safety of both regimens was comparable.
Conclusions
Abatacept and csDMARDs showed comparable effects on the development and stabilization of RA-ILD. Nevertheless, compared to csDMARDs, abatacept demonstrated a significant improvement in disease activity and led to reduced glucocorticoid use.

Keyword

Arthritis, rheumatoid; Lung diseases, interstitial; Disease progression; Abatacept; Antirheumatic agents