POS0513\u2005ABATACEPT IN MONOTHERAPY VERSUS COMBINED IN INTERSTITIAL LUNG DISEASE OF RHEUMATOID ARTHRITIS. MULTICENTER STUDY OF 263 CAUCASIAN PATIENTS

Abstract

<jats:sec><jats:p>Interstitial lung disease (ILD) is a severe complication of RA. Abatacept (ABA) have demonstrated efficacy in RA-ILD [1,2], although combined treatment with MTX or others DMARDs remain controversial.</jats:p></jats:sec><jats:sec><jats:p>To assess the efficacy and safety of ABA in monotherapy (ABA<jats:sub>MONO</jats:sub>) versus combined-ABA, ABA plus MTX(ABA<jats:sub>MTX</jats:sub>) or ABA plus other non-MTX DMARDs (ABA<jats:sub>NON-MTX</jats:sub>), in RA-ILD.</jats:p></jats:sec><jats:sec><jats:p>Observational multicenter study of RA-ILD caucasian patients treated with ABA. We analyzed in three groups (ABA<jats:sub>MONO</jats:sub>, ABA<jats:sub>MTX</jats:sub>, ABA<jats:sub>NON-MTX</jats:sub>) the following outcomes: <jats:bold>a</jats:bold>) Dyspnea, <jats:bold>b</jats:bold>) FVC and DLCO, <jats:bold>c</jats:bold>) HRCT, <jats:bold>d</jats:bold>) DAS28-ESR, <jats:bold>e</jats:bold>) corticosteroid-sparing effect. Differences between basal and final follow-up were evaluated. Multivariable linear regression was used between the three groups.</jats:p></jats:sec><jats:sec><jats:p>We studied 263 RA-ILD patients (mean age 64.6±10 years) [ABA<jats:sub>MONO</jats:sub> (n=111), ABA<jats:sub>MTX</jats:sub> (n=46) and ABA<jats:sub>NON-MTX</jats:sub> (n=106)]. At baseline, ABA<jats:sub>MONO</jats:sub> patients were older (67±10 years) and took higher prednisone dose (10 [IQR 5-15] mg/day). There was no statistically significant differences in sex, seropositivity, ILD patterns, FVC, DLCO or disease duration. In all groups, most patients experienced stabilization or improvement in FVC, DLCO, dyspnea, HRCT as well as improvement in DAS28-ESR. A statistically significant difference between basal and final follow-up was only found in corticosteroid-sparing effect in ABA<jats:sub>MTX</jats:sub> or ABA<jats:sub>NON-MTX</jats:sub>(Figure 1<jats:bold>).</jats:bold> However, in the multivariable analysis, there were no differences in any outcome between the three groups(Table 1).</jats:p><jats:table-wrap id= T1 position= float orientation= portrait ><jats:label>Table 1.</jats:label><jats:caption><jats:p>Effect in FVC, DLCO, dyspnea (mMRC) and HRCT pulmonary scan after abatacept.</jats:p></jats:caption><jats:table><jats:tbody><jats:tr><jats:td align= left rowspan= 2 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 ><jats:bold>ABA</jats:bold><jats:sub><jats:bold>MONO</jats:bold></jats:sub><jats:break /><jats:bold>N=111</jats:bold></jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 ><jats:bold>ABA</jats:bold><jats:sub><jats:bold>MTX</jats:bold></jats:sub><jats:break /><jats:bold>N=46</jats:bold></jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 ><jats:bold>ABA</jats:bold><jats:sub><jats:bold>NON-MTX</jats:bold></jats:sub><jats:break /><jats:bold>N=106</jats:bold></jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 ><jats:bold>ABA</jats:bold><jats:sub><jats:bold>MTX</jats:bold></jats:sub><jats:bold>vs ABA</jats:bold><jats:sub><jats:bold>MONO</jats:bold></jats:sub></jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 ><jats:bold>ABA</jats:bold><jats:sub><jats:bold>NON-MTX</jats:bold></jats:sub><jats:bold>vs ABA</jats:bold><jats:sub><jats:bold>MONO</jats:bold></jats:sub></jats:td><jats:td align= center rowspan= 1 colspan= 1 /></jats:tr><jats:tr><jats:td align= left rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 >p</jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 >p</jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 >p</jats:td><jats:td align= center rowspan= 1 colspan= 1 >p*</jats:td><jats:td align= center rowspan= 1 colspan= 1 >Unadjusted</jats:td><jats:td align= center rowspan= 1 colspan= 1 >Adjusted**</jats:td><jats:td align= center rowspan= 1 colspan= 1 >Unadjusted</jats:td><jats:td align= center rowspan= 1 colspan= 1 >Adjusted**</jats:td></jats:tr><jats:tr><jats:td align= left rowspan= 1 colspan= 1 >Follow-up, median [IQR] months</jats:td><jats:td align= center rowspan= 1 colspan= 1 >12 [6-36]</jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 >12 [6-36]</jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 >18[12-36]</jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 >0.40</jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 >0.67</jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 >0.17</jats:td></jats:tr><jats:tr><jats:td align= left colspan= 12 rowspan= 1 ><jats:bold>Differences between basal and final follow-up</jats:bold></jats:td></jats:tr><jats:tr><jats:td align= left rowspan= 1 colspan= 1 >FVC, %</jats:td><jats:td align= center rowspan= 1 colspan= 1 >-0.5 (-2.5, 1.5)</jats:td><jats:td align= center rowspan= 1 colspan= 1 >0.64</jats:td><jats:td align= center rowspan= 1 colspan= 1 >1.2(-0.6, 3.1)</jats:td><jats:td align= center rowspan= 1 colspan= 1 >0.17</jats:td><jats:td align= center rowspan= 1 colspan= 1 >-1.2 (-2.9, 0.5)</jats:td><jats:td align= center rowspan= 1 colspan= 1 >0.17</jats:td><jats:td align= center rowspan= 1 colspan= 1 >0.33</jats:td><jats:td align= center rowspan= 1 colspan= 1 >0.30</jats:td><jats:td align= center rowspan= 1 colspan= 1 >0.39</jats:td><jats:td align= center rowspan= 1 colspan= 1 >0.59</jats:td><jats:td align= center rowspan= 1 colspan= 1 >0.90</jats:td></jats:tr><jats:tr><jats:td align= left rowspan= 1 colspan= 1 >DLCO, %</jats:td><jats:td align= center rowspan= 1 colspan= 1 >1.8 (-0.7, 4.34)</jats:td><jats:td align= center rowspan= 1 colspan= 1 >0.16</jats:td><jats:td align= center rowspan= 1 colspan= 1 >0.5 (-3.8, 4.8)</jats:td><jats:td align= center rowspan= 1 colspan= 1 >0.82</jats:td><jats:td align= center rowspan= 1 colspan= 1 >-1.5 (-4.1, 1.1)</jats:td><jats:td align= center rowspan= 1 colspan= 1 >0.26</jats:td><jats:td align= center rowspan= 1 colspan= 1 >0.20</jats:td><jats:td align= center rowspan= 1 colspan= 1 >0.58</jats:td><jats:td align= center rowspan= 1 colspan= 1 >0.80</jats:td><jats:td align= center rowspan= 1 colspan= 1 >0.07</jats:td><jats:td align= center rowspan= 1 colspan= 1 >0.32</jats:td></jats:tr><jats:tr><jats:td align= left rowspan= 1 colspan= 1 >mMRC, n (%)</jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /></jats:tr><jats:tr><jats:td align= left rowspan= 1 colspan= 1 >Worsening</jats:td><jats:td align= center rowspan= 1 colspan= 1 >5 (5)</jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 >3 (8)</jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 >5 (5)</jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 2 colspan= 1 >0.83</jats:td><jats:td align= center rowspan= 2 colspan= 1 /><jats:td align= center rowspan= 2 colspan= 1 >0.47</jats:td><jats:td align= center rowspan= 2 colspan= 1 /><jats:td align= center rowspan= 2 colspan= 1 >0.99</jats:td></jats:tr><jats:tr><jats:td align= left rowspan= 1 colspan= 1 >Stable or improving</jats:td><jats:td align= center rowspan= 1 colspan= 1 >93 (95)</jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 >36 (92)</jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 >87 (95)</jats:td><jats:td align= center rowspan= 1 colspan= 1 /></jats:tr><jats:tr><jats:td align= left rowspan= 1 colspan= 1 >HRCT pulmonary scan, n (%)</jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 /></jats:tr><jats:tr><jats:td align= left rowspan= 1 colspan= 1 >Worsening</jats:td><jats:td align= center rowspan= 1 colspan= 1 >13 (28)</jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 >2 (11)</jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 1 colspan= 1 >15 (25)</jats:td><jats:td align= center rowspan= 1 colspan= 1 /><jats:td align= center rowspan= 2 colspan= 1 >0.24</jats:td><jats:td align= center rowspan= 2 colspan= 1 /><jats:td align= center rowspan= 2 colspan= 1 >0.10</jats:td><jats:td align= center rowspan= 2 colspan= 1 /><jats:td align= center rowspan= 2 colspan= 1 >0.78</jats:td></jats:tr><jats:tr><jats:td align= left rowspan= 1 colspan= 1 >Stable or improving</jats:td><jats:td align= center rowspan= 1