2173: Window of Opportunity in the Treatment of Rheumatoid Arthritis-Interstitial Lung Disease with Abatacept. National Multicenter Study of 509 Patients
Hospital Universitario Marqués de Valdecilla, IDIVAL Santander, Spain
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Ana Serrano-Combarro1, Belén Atienza-Mateo2, libe Ibarrola-Paino3, Ivette Casafont-Sole4, Rafael Benito Melero-Gonzalez5, Alba Perez Linaza6, Santos Castañeda7, Rafaela Ortega Castro8, Natalia Mena Vazquez9, Nuria Vegas Revenga10, Lucia Cristina Dominguez Casas11, Cilia Peralta12, Trinidad Pérez-Sandoval13, Lorena Perez-Albadalejo14, Ruben Lopez-Sanchez15, MARIA GUADALUPE MANZANO CANABAL16, Anahy Maria Brandy-Garcia17, Patricia Lopez-Viejo18, Gema Bonilla19, Olga Maiz-Alonso20, Carmen carrasco-Cubero21, Marta Garijo Bufort22, Mireia Moreno23, Ana Urruticoechea24, Sergio Ordonez-Palau25, Carmen Gonzalez-Montagut Gomez26, andrea Garcia-Valle27, Juan Ramon De Dios Jimenez De Aber28, Fernando Lozano29, Tomás Vazquez-Rodriguez30, Maria Martin-Lopez31, Juan Maria Blanco-Madrigal32, Delia Fernández-Lozano33, Ignacio Brana Abascal34, Jesus Loarce-Martos35, Emilio Giner-Serret36, Virginia Ruiz-Esquide37, Clara ventin-Rodriguez38, Marina Rodriguez-lopez39, Pablo Andujar-Brazal40, Julia Fernandez-Melon41, Lilian Maria Lopez42, carlos Fernandez-Diaz43, Javier Loricera44, Ivan Ferraz Amaro45, Diego Ferrer46, Ricardo Blanco47 and On behalf of the Collaborative Group Members48, 1Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain, 2Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, 3Hospital Universitario de Navarra, Pamplona, Spain, 4Hospital Universitari Germans Trias i Pujol, Badalona, Spain, 5CHU Vigo, O Carballino, Spain, 6SERV. REUMATOLOGIA, Cadiz, Spain, 7Hospital Universitario de la Princesa, Madrid, Spain, 8Hospital Reina Sofía, Cordoba, Spain, 9IBIMA, Málaga, Spain, 10Hospital Galdakao- Usansolo, Galdakao, Spain, 11Hospital Universtario San Agustin, Oviedo, Spain, 12Hospital Clínico Lozano Blesa, Zaragoza, Spain, 13Hospital de León, León, Spain, 14Division of Rheumatology, Hospital Universitario de Jaén, Jaén, Spain, 15Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain, 16CAZA, Salamanca, Spain, 17Hospital Germans Trias i Pujol, Badalona, Spain, 18Division of Rheumatology, Hospital Severo Ochoa, Leganéz, Spain, 19Department of Rheumatology, Hospital Clínico Universitario La Paz, Madrid, Spain, 20University Hospital Donostia, San Sebastian, Spain, 21Department of Rheumatology, Hospital Universitario de Badajoz, Badajoz, Spain, 22Hospital de Sagunto, Valencia, Spain, 23Parc Tauli Hospital Universitari, I3PT(UAB), Barcelona, Spain, 24Hospital Can Misses, Ibiza, Spain, 25H. Arnau de Vilanova, Lleida, Spain, 26H. Clínico Universitario de Valladolid, Valladolid, Spain, 27Division of Rheumatology, Complejo Asistencial Universitario de Palencia, Palencia, Spain, 28Hospital de Araba, Alava, Spain, 29Hospital Universitario 12 de Octubre, Madrid, Spain, 30Rheumatology, Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain, 31Hospital 12 de Octubre, Madrid, Spain, 32Division of Rheumatology, H. Universitario de Basurto, Bilbao, Spain, 33Hospital de Mérida, Merida, Spain, 34Division of Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain, 35Ramón y Cajal University Hospital, Madrid, Spain, 36Hospital Royo Villanova, Teruel, Spain, 37Hospital Clinic, Rheumatology, Barcelona, Spain, 38Division of Rheumatology, Hospital Universitario de A Coruña, A Coruña, Spain, 39Division of Rheumatology, Hospital Clínico Universitario de Santiago, La Coruna, Spain, 40Division of Rheumatology, Hospital Universitario Doctor Peset, Valencia, Spain, 41Division of Rheumatology, Hospital Universitario Son Espases, Palma de Mallorca, Spain, 42Division of Rheumatology, Hospital Universitario Son Llàtzer, Mallorca, Spain, 43Division of Rheumatology, Hospital Universitario Reina Sofía, Murcia, Spain, 44Hospital Universitario Marqués de Valdecilla, Santander, Spain, 45Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain, 46Division of Pneumology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, 47Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, 48Spanish Collaborative Group of Interstitial Lung Disease Associated with Rheumatoid Arthritis, Spain, Spain
Background/Purpose: Interstitial lung disease (ILD) is a severe complication of rheumatoid arthritis (RA). Abatacept (ABA) has demonstrated efficacy in the treatment of RA-ILD, especially if it is initiated early during the ILD. Our objective was to compare the efficacy of ABA in RA-ILD patients according to ILD duration.
Methods: National multicenter study of 509RA-ILD patients treated with ABA. Patients with ABA initiation early in the disease (during the first 6 months since ILD diagnosis) were compared to those in whom ABA was started after 2 years of ILD diagnosis ("early" vs. "late" group, respectively). We analyzed in the 2 groups the following outcomes: a) forced vital capacity (FVC), b) diffusing capacity of the lungs for carbon monoxide (DLCO), c) chest high resolution computed tomography (HRCT), d)dyspnea (modified Medical Research Council scale), and e) arthritis activity (DAS28-ESR or clinical records).
Results: A total of 216 patients were included in the "early" group and 165 patients in the "late" group. Baseline demographic and clinical characteristics are shown in Table 1. Mean baseline values of FVC were significantly higher in the "early" group. The evolution of FVC and DLCO for 48 months is shown in Figure 1. Both parameters remained stable during 48 months of ABA therapy, with statistically significant differences found in case of FVC (although lower stable values of FVC in the "late" group). Available chest HRCT images improved/ stabilized in 76% and 54% of patients in the "early" and "late" group, respectively. Stabilization or improvement of dyspnea was found in most patients of both groups.
Conclusion: Our study suggests a window of opportunity for the treatment of RA-ILD patients with ABA. However, treatment with ABA at any time of the course in the ILD seems to prevent interstitial lung progression.
Table 1. Main general features at baseline of RA-ILD patients with “early” vs. “late” initiation of ABA in ILD course.
Figure 1. Evolution of pulmonary function tests in RA-ILD patients with “early” and “late” initiation of ABA in ILD course. FVC and DLCO are expressed as mean (95%CI) and compared between the 2 groups. (*) P value is statistically significant in FVC at baseline, 24, 36 and 48 months of follow up.
A. Serrano-Combarro: None; B. Atienza-Mateo: None; l. Ibarrola-Paino: None; I. Casafont-Sole: None; R. Melero-Gonzalez: None; A. Perez Linaza: None; S. Castañeda: None; R. Ortega Castro: None; N. Mena Vazquez: None; N. Vegas Revenga: None; L. Dominguez Casas: None; C. Peralta: None; T. Pérez-Sandoval: None; L. Perez-Albadalejo: None; R. Lopez-Sanchez: None; M. MANZANO CANABAL: None; A. Brandy-Garcia: None; P. Lopez-Viejo: None; G. Bonilla: None; O. Maiz-Alonso: None; C. carrasco-Cubero: None; M. Garijo Bufort: None; M. Moreno: None; A. Urruticoechea: None; S. Ordonez-Palau: None; C. Gonzalez-Montagut Gomez: None; a. Garcia-Valle: None; J. Dios Jimenez De Aber: None; F. Lozano: None; T. Vazquez-Rodriguez: None; M. Martin-Lopez: None; J. Blanco-Madrigal: None; D. Fernández-Lozano: None; I. Brana Abascal: None; J. Loarce-Martos: Boehringer-Ingelheim, 6, Bristol-Myers Squibb(BMS), 6, Galapagos, 6; E. Giner-Serret: None; V. Ruiz-Esquide: None; C. ventin-Rodriguez: None; M. Rodriguez-lopez: None; P. Andujar-Brazal: None; J. Fernandez-Melon: None; L. Lopez: None; c. Fernandez-Diaz: None; J. Loricera: None; I. Ferraz Amaro: AbbVie/Abbott, 5, 6, Amgen, 5, 6, Bristol-Myers Squibb(BMS), 6; D. Ferrer: None; R. Blanco: AbbVie, 5, 6, Amgen, 6, AstraZeneca, 2, BMS, 6, Eli Lilly, 6, Galapagos, 2, 6, Janssen, 2, 6, MSD, 6, Novartis, 2, 6, Pfizer, 2, 6, Roche, 5, 6, Sanofi, 6; O. Collaborative Group Members: None.
