Target trial emulation of biologic and targeted synthetic disease-modifying antirheumatic drugs for rheumatoid arthritis-associated interstitial lung disease
Authors' conclusion
In target trial emulations, there were no statistically significant differences between rituximab and other b/tsDMARDs for the primary composite outcome. However, abatacept and JAKi were associated with reduced mortality.
Study context
- Population
- RA-ILD patients, Medicare data 2006–2019, initiating b/tsDMARDsPropensity score (PS)-matched cohorts
- Exposure
- Abatacept, janus kinase inhibitors (JAKi), IL-6i or tumor necrosis factor inhibitors (TNFi) initiators, each vs PS-matched rituximab initiators
- Abataceptn = 694
- JAKin = 156
- IL-6in = 389
- TNFin = 734
- Outcome
- Composite of:
- Respiratory hospitalization
- Lung transplant
- Death
Methodological detailsobservational cohort study, propensity-score matched, separate two-way comparisons, intention-to-treat framework, Cox proportional hazards regression
- Observational cohort study
- Propensity-score matched
- Separate two-way comparisons
- Intention-to-treat framework
- Cox proportional hazards regression
Main finding
As reported in the abstract
Each group vs rituximabHazard ratio (95% CI)
Abatacept
0.87(0.75–1.00)
JAKi
0.74(0.51–1.08)
IL-6i
1.08(0.88–1.33)
TNFi
1.09(0.95–1.25)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| MortalityAbataceptvs Rituximab | 0.84 (0.71–0.98) | |
| MortalityJAKivs Rituximab | 0.62 (0.40–0.96) | |
| 0.512Hazard ratio (log scale) |
Mortality
- Abatacept and JAKi associated with lower mortality vs rituximab
Original publication
Target trial emulation of biologic and targeted synthetic disease-modifying antirheumatic drugs for rheumatoid arthritis-associated interstitial lung disease. Semin Arthritis Rheum. Published 25 March 2026. doi:10.
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