TNF inhibitors do not increase adverse event risk in rheumatoid arthritis-associated ILD
Key takeaways:
- Patients treated with TNF inhibitors had respiratory hospitalization and mortality rates similar to patients on other DMARDs.
- TNF inhibitors ‘can remain a therapeutic option’ for RA-ILD.
Treatment with TNF inhibitors yielded no differences in outcomes vs. other antirheumatic therapies among U.S. veterans with rheumatoid arthritis-associated interstitial lung disease, according to data published in The Lancet Rheumatology.
“There has been concern among providers about whether it is safe to use TNF inhibitors in patients with RA-ILD,” Bryant R. England, MD, PhD, associate professor at the University of Nebraska Medical Center, told Healio. “Since TNF inhibitors are the most commonly used biologic in RA, it was important to investigate outcomes following their use in RA-ILD, a population with increased morbidity and mortality.”
To compare outcomes among patients with RA-ILD who received TNF-inhibitor vs. non-TNF inhibitor biological or targeted synthetic DMARDs, England and colleagues conducted a target trial emulation using U.S. Department of Veterans Affairs health records. A total of 1,047 patients were identified with validated algorithms, and 237 from each of the two treatment groups were propensity score matched in a 1:1 ratio (overall mean age, 68 years; 8% women). The primary outcome was a composite of death or respiratory hospitalization for up to 3 years post-treatment initiation.
After propensity score matching, the non-TNF inhibitor group demonstrated no significant increased risk compared with the TNF inhibitor group, showing an adjusted hazard ratio of 1.21 (95% CI, 0.92-1.58), according to the researchers. Beyond the composite outcome, there were also no significant differences in respiratory hospitalization (adjusted HR = 1.27; 95% CI, 0.91-1.76), all-cause mortality (adjusted HR = 1.15; 95% CI, 0.83-1.6) or respiratory mortality (adjusted HR = 1.38; 95% CI, 0.79-2.42).
The results suggest “systematic avoidance” of TNF inhibitors is unnecessary in this patient population, the researchers wrote.
“Based on prior smaller studies, we expected that the non-TNF-inhibitor-treated patients might have better outcomes,” England said. “But after accounting for a large number of clinical factors that could influence which medicine patients received and their prognosis, we found no differences in survival or respiratory hospitalization risk.
“TNF inhibitors do not need to be avoided in all patients with RA-ILD,” he added. “They can remain a therapeutic option for patients.”
Still, England acknowledged some inherent limitations of the methodology.
“Even when we use our best designs and tools to emulate a clinical trial using real-world data, there is still the possibility of selection or confounding bias affecting results,” he told Healio. “For example, we were unable to ascertain the clinical decisions that led to starting each medicine, which could have been focused on treating joint disease, lung disease or both. Thus, although RA-ILD is a rare disease that has not had a history of successful trials, it is important for the field to work together to conduct clinical trials evaluating the effectiveness of available and novel treatments.”
For more information:
Bryant R. England, MD, PhD, can be reached at bryant.england@unmc.edu.
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