Patients with rheumatoid arthritis starting bDMARDs have higher ILD risk vs those with PsA
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Key takeaways:
- ILD was more likely in patients with RA starting biologic DMARDs vs. those with PsA initiating biologic DMARDs or the general population.
- Methotrexate co-medication is not a risk factor for ILD.
Patients with rheumatoid arthritis or psoriatic arthritis starting biologic disease-modifying antirheumatic drugs have a higher risk for interstitial lung disease vs. the general population, with the highest risk found in RA, data show.
The study, published in The Journal of Rheumatology, additionally found that adding methotrexate to biologic DMARD treatment did not increase either group’s risk for ILD.
“Interstitial lung disease is one of the most common pulmonary manifestations of rheumatoid arthritis, but its prevalence has not been investigated in psoriatic arthritis,” Sella A. Provan, MD, PhD, of the Center for Treatment of Rheumatic and Musculoskeletal Diseases at Diakonhjemmet Hospital, in Norway, and colleagues wrote.
“The role of methotrexate in ILD development remains contentious,” they added.
To investigate the relative prevalence of ILD in patients with RA and PsA starting their first biologic DMARD, as well as potential links with methotrexate, Provan and colleagues analyzed data from five Nordic rheumatology registries. Data representing 29,478 patients with RA (mean age, 56 years) and 10,919 patients with PsA (mean age, 49 years) were compared with matched general population data, representing 362,087 individuals, from four countries.
The follow-up period began with the first dose of biologic DMARD treatment and ended with the first incidence of ILD, death, the passage of 5 years since the start of follow-up, or the end of the study period. ILD incidence was compared with the general population using Cox proportional hazards regression models, while separate models adjusted for age and sex were used to assess ILD risk with methotrexate co-medication in RA and PsA.
Overall, there were 225 cases of ILD among patients with RA, 23 among patients with PsA and 251 among the general population. Compared with the general population, patients with RA were at higher risk (HR = 9.7; 95% CI, 8-11.9) than patients with PsA (HR = 4.4; 95% CI, 2.8-7), according to the researchers.
Methotrexate appeared to have no effect on risk for ILD in either RA or PsA, the researchers added. Compared with non-use, the HR with co-medication was 0.9 (95% CI, 0.7-1.2) in RA and 1 (95% CI, 0.2-2.2) in PsA.
However, the statistical analysis did reveal potential additional risks in RA.
“The proportional hazards assumption was violated in the RA population, and a time-varying Cox regression model indicated an increased risk in the RA population treated with methotrexate for the first 8 months,” Provan and colleagues wrote. “Our sensitivity analyses restricted to [the ICD10 J84/J99 definition of ILD] confirmed the main results.”
The researchers concluded that ILD is particularly more common among RA vs. the general population than in PsA.
“In this treatment context, methotrexate is not a risk factor for ILD in the PsA population,” Provan and colleagues wrote. “In patients with RA who are treated with methotrexate co-medication, we cannot exclude the possibility of an increased risk during the first 8 months of bDMARD therapy.”
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