The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Effect of abatacept versus conventional synthetic disease modifying anti-rheumatic drugs on rheumatoid arthritis-associated interstitial lung disease

  • Kyung-Ann Lee (Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital) ;
  • Bo Young Kim (Division of Rheumatology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Sung Soo Kim (Division of Rheumatology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine) ;
  • Yun Hong Cheon (Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Sang-Il Lee (Division of Rheumatology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine) ;
  • Sang-Hyon Kim (Division of Rheumatology, Department of Internal Medicine, Keimyung University Dongsan Medical Center) ;
  • Jae Hyun Jung (Division of Rheumatology, Department of Internal Medicine, Korea University Ansan Hospital) ;
  • Geun-Tae Kim (Division of Rheumatology, Department of Internal Medicine, Kosin University Gospel Hospital) ;
  • Jin-Wuk Hur (Division of Rheumatology, Department of Internal Medicine, Nowon Eulji Medical Center) ;
  • Myeung-Su Lee (Division of Rheumatology, Department of Internal Medicine, Wonkwang University Hospital) ;
  • Yun Sung Kim (Division of Rheumatology, Department of Internal Medicine, Chosun University Hospital) ;
  • Seung-Jae Hong (0Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Medical Center) ;
  • Suyeon Park (Biostatistics, Soonchunhyang University Seoul Hospital) ;
  • Hyun-Sook Kim (Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital)
  • Received : 2023.05.08
  • Accepted : 2023.12.11
  • Published : 2024.09.01
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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.

Keywords

Acknowledgement

This research was supported by a grant from the Soonchunhyang University Research Fund, Bristol Myers Squibb Pharmaceutical Company (Seoul, Korea) and the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC21C0100).

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