Risk of interstitial lung disease (ILD) and safety outcomes across disease-modifying antirheumatic drug (DMARD) classes in rheumatoid arthritis and RA-associated ILD (RA-ILD)
Authors' conclusion
DMARD class was not associated with ILD incidence or ILD-related hospitalisation. Non-TNFi biologics were consistently linked to increased pneumonia-related hospitalisation, recurrence, and mortality
Study context
- Population
- Adults with newly diagnosed rheumatoid arthritis (RA) prescribed at least one csDMARD, Korean National Health Insurance Service data (2011–2020), followed until 2022; including RA-ILD (≥2 ILD claims plus chest CT confirmation)641 RA-ILD
- Participants
- 26,120 adults
- Exposure
- TNFi, non-TNFi biologics and JAKi vs csDMARDs
- Outcome
- ILD incidence
Methodological detailsnationwide, time-varying Cox models, inverse probability of treatment weighting
- Nationwide
- Time-varying Cox models
- Inverse probability of treatment weighting
Main finding
As reported in the abstract
ILD incidence (adjusted)
- Adjusted ILD incidence was similar across DMARD classes
Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | |
|---|---|---|
| HospitalisationNon-TNFi biologicsvs csDMARDsRA | 1.30 (1.21–1.40) | |
| HospitalisationNon-TNFi biologicsvs csDMARDsRA-ILD | 1.35 (1.02–1.80) | |
| All-cause mortalityNon-TNFi biologicsvs csDMARDsRA | 4.09 (3.04–5.50) | |
| All-cause mortalityNon-TNFi biologicsvs csDMARDsRA-ILD | 4.31 (2.21–8.41) | |
| 0.10.31310Adjusted hazard ratio (log scale) |
Hospitalisation
- TNFi and JAKi showed no significant associations with hospitalisation
ILD-related admissions
- Similar across groups; pneumonia-related hospitalisations and recurrences higher with non-TNFi biologics
Safety
| Outcome | aHR (95% CI) | |
|---|---|---|
| InfectionNon-TNFi biologicsvs csDMARDsRA | 1.16 (1.05–1.28) | |
| InfectionNon-TNFi biologicsvs csDMARDsRA-ILD | 1.51 (1.06–2.15) | |
| 0.512Adjusted hazard ratio (log scale) |
Infection
- TNFi and JAKi showed no significant associations with infection
MACE
- MACE risk did not differ across groups
Original publication
Risk of ILD and safety outcomes across DMARD classes in rheumatoid arthritis and RA-ILD. Semin Arthritis Rheum. Published 11 January 2026. doi:10.
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