Rituximab Could Effectively Treat RA Lung Disease

Rituximab (RTX) could be a good option to treat patients with rheumatoid arthritis (RA) and interstitial lung disease (ILD), according to the results of a recent study.

The researchers conducted an observational study of patients with RA-ILD, using data from a cohort of RTX-treated RA patients. Disease progression was defined as a decrease of pre-RTX forced vital capacity >10% or diffusion capacity of carbon monoxide >15% predicted, worsening of the ILD score, or death related to progressive ILD.
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Overall, 56 of the 700 RA patients had RA-ILD. Following RTX treatment, new cases of ILD were diagnosed in 3 patients. Lung assessment data was available for 44 of the 56 patients.

The researchers found that the median relative change pre- and post-RTX treatment were -2.4% and +1.2% for forced vital capacity and -4.4% and -1.3% for diffusion capacity of carbon monoxide. Following RTX treatment, 23 of 44 patients were stable, 7 had improved, and 14 had ILD that progressed. Previous history of lung progression and pre-RTX treatment diffusion capacity of carbon monoxide <46% were associated ILD progression. Of the 14 with ILD progression, 11 had severe ILD before RTX treatment.

“In this cohort of patients where RTX was given for arthritis, most patients with ILD pre-RTX remained stable/improved after treatment over a prolonged follow-up period. Patients who deteriorated/died had the most severe ILD pre-RTX, suggesting the drug was not contributory. RTX appears to be an acceptable therapeutic choice for patients with RA-ILD and further studies are warranted.”

—Michael Potts

Reference:

Yusof Y, Kabia A, Darby M, et al.  Effect of rituximab on the progression of rheumatoid arthritis–related interstitial lung disease: 10 years’ experience at a single centre. Rheumatology. 2017;56(8):1348-1357.