Effectiveness and tolerability of antifibrotics in rheumatoid arthritis-associated interstitial lung disease
Authors' conclusion
In this first real-world study of antifibrotic use dedicated to RA-ILD, antifibrotic initiation was associated with a modestly improved trajectory of FVCpp. AEs were frequently reported, particularly GI, and discontinuation was common.
Study context
- Population
- Patients with definite RA-ILD (Bongartz criteria; 2010 ACR/EULAR RA criteria) initiating antifibrotics, Mass General Brigham, Boston, MA, USA, 2014–2023 (mean age 67.8 years, 53 % male)
- Participants
- 74 patients
- Exposure
- FVCpp trajectory before vs after antifibrotic initiation
- Nintedanibn = 40
- Pirfenidonen = 34
- Outcome
- Within-patient trajectory (slope) of FVCpp
- Follow-up
- 18 months before to 18 months after initiation
Methodological detailsreal-world, multi-hospital, linear mixed model with random intercept, Kaplan-Meier and Cox regression
- Real-world
- Multi-hospital
- Linear mixed model with random intercept
- Kaplan-Meier and Cox regression
Main finding
As reported in the abstract
Estimated slope of FVCpp
After initiation
−0.3
% per year
Before initiation
−6.2
% per year
P = 0.03
Observational data: associations, not effects.
Further findings
- Median drug retention time — Median drug retention time, weeks · Nintedanib vs Pirfenidone · no difference
- 142 (95 %CI 56, 262) · P = 0.68
FVCpp trajectory by drug
- Nintedanib and pirfenidone had similar FVCpp trajectory
Death and lung transplantation during follow-up · median follow-up 89 weeks (min 4, max 387)
- Died
- 26 (35 %)
- Lung transplantation
- 4 (5 %)
- Male sex and heavy smoking each associated with lung transplant or mortality
Safety
Adverse events (AEs)
- Any AE
- 41 (55 %)
- Gastrointestinal (GI) AEs (most common)
- 30
Discontinuation of initial antifibrotic
- Discontinued
- 34 (46 %)
- Due to GI AEs
- 19
Original publication
Effectiveness and tolerability of antifibrotics in rheumatoid arthritis-associated interstitial lung disease. Semin Arthritis Rheum. Published 24 November 2023. doi:10.
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