Real-world association of biologic and targeted synthetic DMARD use with mortality in rheumatoid arthritis-associated interstitial lung disease: a nationwide cohort study
Main finding · All-cause mortalityResult — go to the resultHazard ratio 0.75 95% CI 0.62–0.89Authors' conclusion
b/tsDMARD use was associated with lower all-cause mortality and respiratory-related mortality in patients with RA-ILD. Further studies incorporating clinical, pulmonary function and radiological data are needed to confirm these findings.
Study context
- Population
- Patients with incident RA-ILD between 2010 and 2021 identified using the National Health Insurance databasepatients with RA-ILD, 1964 deaths occurred
- Participants
- 6,292 patients
- Exposure
- b/tsDMARD use vs non-b/tsDMARDs
- b/tsDMARDn = 1,074
- Conventional synthetic DMARDs onlyn = 5,218reference
- Outcome
- All-cause mortality
Methodological detailstime-dependent exposure, inverse probability of treatment weighting (IPTW), time-dependent Cox proportional hazards models, time-dependent Fine-Grey competing-risk models
- Time-dependent exposure
- Inverse probability of treatment weighting (IPTW)
- Time-dependent Cox proportional hazards models
- Time-dependent Fine-Grey competing-risk models
Main finding
As reported in the abstract
Hazard ratio
0.75
95% CI 0.62–0.89
b/tsDMARDvs conventional synthetic DMARDs only
HR 0.75 (95% CI 0.62–0.89)
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | |
|---|---|---|
| Respiratory-related mortalityAfter IPTW | sHR 0.72 (95% CI 0.56–0.91) | |
| ILD-related mortality nested within respiratory mortalityAfter IPTW | sHR 0.63 (95% CI 0.43–0.88) | |
| All-cause mortality, class-specific analyses versus non-b/tsDMARDsTumour necrosis factor inhibitorsvs non-b/tsDMARDs | HR 0.61 (95% CI 0.44–0.86) | |
| All-cause mortality, class-specific analyses versus non-b/tsDMARDsAbataceptvs non-b/tsDMARDs | HR 0.71 (95% CI 0.53–0.9) | |
| All-cause mortality, class-specific analyses versus non-b/tsDMARDsTocilizumabvs non-b/tsDMARDs | HR 0.68 (95% CI 0.52–0.89) | |
| All-cause mortality, class-specific analyses versus non-b/tsDMARDsRituximabvs non-b/tsDMARDs | HR 0.76 (95% CI 0.28–2.06) | |
| All-cause mortality, class-specific analyses versus non-b/tsDMARDsJanus kinase inhibitorsvs non-b/tsDMARDs | HR 0.61 (95% CI 0.39–0.95) | |
| 0.20.5125Ratio (log scale) |
Cardiovascular, cancer-related or infection-related mortality
- No statistically significant associations were observed
Original publication
Real-world association of biologic and targeted synthetic DMARD use with mortality in rheumatoid arthritis-associated interstitial lung disease: a nationwide cohort study. RMD Open. Published 23 October 2026. doi:10.
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