2165: Efficacy of Abatacept in Rheumatoid Arthritis- associated Usual Interstitial Pneumonia. National Multicenter Study of 233 Patients During a Long-Term Follow Up

Belén Atienza-Mateo¹, Ana Serrano-Combarro², Natividad del Val del Amo³, Ivette Casafont-Sole⁴, Rafael Benito Melero-Gonzalez⁵, Isabel Serrano-García⁶, Santos Castañeda⁷, Jerusalem Calvo⁸, Natalia Mena Vazquez⁹, Nuria Vegas Revenga¹⁰, Lucía Domínguez-Casas¹¹, Maria Camila Osorio Sanjuan¹², Carolina Díez Morrondo¹³, Lorena Perez-Albadalejo¹⁴, Ruben Lopez-Sanchez¹⁵, Maria Guadalupe Mazano 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 Dios²⁸, Fernando Lozano²⁹, Tomás Vazquez-Rodriguez³⁰, Patricia Carreira²⁹, Juan Maria Blanco-Madrigal³¹, SARA MARIA ROJAS HERRERA³², Ignacio Brana Abascal³³, Jesus Loarce-Martos³⁴, Emilio Giner-Serret³⁵, Juan Camilo Sarmiento-Monroy³⁶, Clara ventin-Rodriguez³⁷, Marina Rodriguez-lopez³⁸, Pablo Andujar-Brazal³⁹, Julia Fernandez-Melon⁴⁰, Lilian Maria Lopez⁴¹, carlos Fernandez-Diaz⁴², Javier Loricera⁴³, Ivan Ferraz Amaro⁴⁴, Diego Ferrer⁴⁵, Ricardo Blanco⁴⁶ and On behalf of the Collaborative Group Members⁴⁷, ¹Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, ²Division of Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Immunopathology group, Santander, Spain, ³Complejo Hospitalario de Navarra, Pamplona, Spain, ⁴Hospital Universitari Germans Trias i Pujol, Badalona, Spain, ⁵CHU Vigo, O Carballino, Spain, ⁶Division of Rheumatology, H. Puerta del Mar, Cádiz, Spain, ⁷Hospital Universitario de la Princesa, Madrid, Spain, ⁸Reina Sofia University Hospital, Córdoba, Spain, ⁹IBIMA, Málaga, Spain, ¹⁰Hospital Galdakao- Usansolo, Galdakao, Spain, ¹¹Division of Rheumatology, Hospital San Agustín, Avilés, Spain, ¹²Division of Rheumatology, H.U. Lozano Blesa, Zaragoza, Spain, ¹³Division of Rheumatology, Hospital 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, ¹⁶Complejo Asistencial de Zamora, Zamora, 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, ²²H. de Sagunto, Valencia, Italy, 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 Universitario Araba, Vitoria, Spain, ²⁹Hospital Universitario 12 de Octubre, Madrid, Spain, ³⁰Rheumatology, Complejo Hospitalario Universitario de Ferrol, A Coruña, Spain, ³¹Division of Rheumatology, H. Universitario de Basurto, Bilbao, Spain, ³²Division of Rheumatology, Hospital de Mérida, Mérida, Spain, ³³Division of Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain, ³⁴Ramón y Cajal University Hospital, Madrid, Spain, ³⁵Hospital Royo Villanova, Teruel, Spain, ³⁶Hospital Clínic, Barcelona, Spain, ³⁷Division of Rheumatology, Hospital Universitario de A Coruña, A Coruña, Spain, ³⁸Division of Rheumatology, Hospital Clínico Universitario de Santiago, La Coruna, Spain, ³⁹Division of Rheumatology, Hospital Universitario Doctor Peset, Valencia, Spain, ⁴⁰Division of Rheumatology, Hospital Universitario Son Espases, Palma de Mallorca, Spain, ⁴¹Division of Rheumatology, Hospital Universitario Son Llàtzer, Mallorca, Spain, ⁴²Division of Rheumatology, Hospital Universitario Reina Sofía, Murcia, Spain, ⁴³Hospital Universitario Marqués de Valdecilla, Santander, Spain, ⁴⁴Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain, ⁴⁵Division of Pneumology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, ⁴⁶Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, ⁴⁷Spanish Collaborative Group of Interstitial Lung Disease Associated with Rheumatoid Arthritis, Spain, Spain

Background/Purpose: Interstitial lung disease (ILD) is a severe extra-articular manifestation of rheumatoid arthritis (RA). Usual interstitial pneumonia (UIP) is the most frequent, and severe ILD pattern in RA. Abatacept (ABA) has demonstrated effectiveness in RA-ILD during a 12-month period of treatment [Rheumatology (Oxford) 2020;59(12):3906-16, Rheumatology (Oxford) 2021;61(1):299-308]. However, little is known about the specific effect of ABA in the UIP pattern. Therefore, the aim of this study was to assess the effectiveness and safety of ABA in RA-ILD patients with radiological pattern of UIP during a long-term follow-up.

Methods: From a large observational multicenter study of 509 RA-ILD patients treated with ABA, we selected those with UIP. The following outcomes were assessed from baseline to final follow-up: a) pulmonary function tests (PFTs) -forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide (DLCO)-, c) chest high resolution computed tomography (HRCT), d)dyspnea (evaluated with the modified Medical Research Council scale), and e) arthritis activity (measured with DAS28-ESR).

Results: We included a total of 233 patients with UIP (118 women/115 men; mean age of 67.5±9.9 years). Table 1 shows baseline demographic and clinical characteristics. The median ILD duration up to ABA initiation was relatively short, with a median [IQR] of 9.5 [2-36] months. Mean baseline values of FVC and DLCO were >80% and >60%, respectively. During a median of 22 [6-43] months of ABA therapy, 73.8% and 59.4% of patients showed an improvement/ stabilization of FVC and DLCO, respectively. Figure 1 displays the evolution of PFTs along 48 months. Available chest HRCT images improved/ stabilized in 67.1% of patients. Stabilization or improvement of dyspnea was found in 79.5% of patients. The majority of patients showed articular remission or low activity (mean DAS28-ESR of 4.4±1.6 at baseline and 2.6±1.3 at 48 months). ABA was withdrawn in 50 (21.5%) patients due to ILD worsening (n=20), articular inefficacy (n=15), serious infections (n=7), and other causes (n=8, development of malignancy in 3, neutrophilic dermatosis in 1, diagnosis of giant cell arteritis and change to tocilizumab in 1, patient's decision in 1, and 2 deceases).

Conclusion: ABA demonstrates a long-term efficacy and safety in patients with RA-associated UIP, the most severe pattern of ILD in RA patients.






B. Atienza-Mateo: None; A. Serrano-Combarro: None; N. del Val del Amo: None; I. Casafont-Sole: None; R. Melero-Gonzalez: None; I. Serrano-García: None; S. Castañeda: None; J. Calvo: None; N. Mena Vazquez: None; N. Vegas Revenga: None; L. Domínguez-Casas: None; M. Osorio Sanjuan: None; C. Díez Morrondo: None; L. Perez-Albadalejo: None; R. Lopez-Sanchez: None; M. Mazano 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. De Dios: None; F. Lozano: None; T. Vazquez-Rodriguez: None; P. Carreira: None; J. Blanco-Madrigal: None; S. ROJAS HERRERA: None; I. Brana Abascal: None; J. Loarce-Martos: Boehringer-Ingelheim, 6, Bristol-Myers Squibb(BMS), 6, Galapagos, 6; E. Giner-Serret: None; J. Sarmiento-Monroy: 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.