Hospital Universitario Marqués de Valdecilla, IDIVAL Santander, Cantabria, Spain
No financial relationships with ineligible companies to disclose
Ana Serrano-Combarro1, Belén Atienza-Mateo2, Jesús Alejandro Valero Jaimes3, Marta Pastor-Mena4, Rafael Benito Melero-Gonzalez5, María Martín López6, Santos Castañeda7, Jesús Loarce8, César Antonio Egües Dubuc9, Natalia Mena Vázquez10, Carmen Carrasco-Cubero11, Carolina Perez-Garcia12, Juan M Blanco Madrigal13, Nuria Vegas Revenga14, Lorena Pérez Albadalejo15, Rafaela Ortega-Castro16, Desiree Palma17, Ana Fernández-Ortiz18, Maria López Lasanta19, Marta Garijo Bufort20, Ivette Casafont-Sole21, Andrea García-Valle22, Maria Paz Martinez-Vidal23, Bryan Josué Flores Robles24, EVELIN CERVANTES PEREZ25, Ignacio Brana Abascal26, Sara María Rojas Herrera27, Juan Camilo Sarmiento-Monroy28, Virginia Ruiz-Esquide29, JOSE RAMON LAMUA RIAZUELO30, Uxue Astigarraga-Urquia31, Diego Ferrer32 and Ricardo Blanco-Alonso33, 1Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain, 2Division of Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Immunopathology group, Santander, Cantabria, Spain, 3Zumarraga Hospital, Zumarraga, Spain, 4Hospital de Jeréz de la Frontera, Cadiz, Spain, 5CHU Ourense, O Carballino, Spain, 6General University Hospital of Ciudad Real, Ciudad de México, Spain, 7Hospital Universitario de la Princesa, Madrid, Spain, 8Ramón y Cajal University Hospital, Madrid, Madrid, Spain, 9Hospital Universitario de Donostia, Donostia, Pais Vasco, Spain, 10IBIMA, Málaga, Andalucia, Spain, 11Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain, 12Hospital del Mar, Barcelona, Spain, 13BASURTO UNIVERSITY HOSPITAL, Bilbao, Spain, 14Hospital Galdakao- Usansolo, Galdakao, Spain, 15Hospital Universitario de Jaén, Jaén, Spain, 16Hospital Reina Sofía, Cordoba, Andalucia, Spain, 17Hospital Rafael Méndez, Lorca, Murcia, Spain, 18Hospital Universitario de Badajoz, Badajoz, Spain, 19Hospital Vall d�Hebron, Barcelona, Spain, 20Hospital de Sagunto, Valencia, Spain, 21Hospital Universitari Germans Trias i Pujol, Badalona, Spain, 22Hospital General Río Carrión, Palencia, Spain, 23Hospital San Juan de Alicante, Alicante, Spain, 24Hospital San Pedro, Logroño, Spain, 25Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Galicia, Spain, 26Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain, 27Hospital de Mérida, Badajoz, Spain, 28Hospital Clínic Barcelona, Barcelona, Spain, 29Hospital Clinic de Barcelona, Barcelona, Spain, 30Hospital Universitario del Henares, Madrid, Spain, 31Hospital Universitario de Navarra, Pamplona, Spain, 32Division of Pneumology, Hospital Universitario Marqués de Valdecilla, Santander, Spain, 33Division of Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Immunopathology group, Santander, Spain Background/Purpose: Interstitial lung disease (ILD) is a severe extraarticular manifestation of rheumatoid arthritis (RA) that determines a worse prognosis, leading the cause of mortality in RA patients, second only to cardiovascular disease. Abatacept and rituximab are the recommended drugs. JAK inhibitors (JAKi) have demonstrated efficacy in RA. The JAKi approved by the Food and Drugs Administration (FDA) and the European Medicines Agency (EMA) for the treatment of RA are tofacitinib (TOFA), baricitinib (BARI), upadacitinib and filgotinib. The evidence on efficacy of BARI in RA-ILD is growing. Our objective is to assess a) the effectiveness and b) the safety of BARI in AR-ILD patients. Methods: National multicenter study of 72 RA-ILD patients on treatment with BARI. We analyzed the following outcomes from baseline:
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), e) arthritis activity (DAS28-ESR or clinical records), and f) sparing corticosteroids effect.
Results: We studied 72 patients (52 women / 20 men; mean age 68
±
10 years) from clinical practice on treatment with BARI. Baseline demographic and clinical characteristics are shown in Table.
All
patients had received disease-modifying antirheumatic drugs (DMARDs) before BARI [Methotrexate (62; 86%), Leflunomide (51; 70%), Sulfasalazine (19; 26%), Abatacept (45; 63%), Tocilizumab (25; 35%), Adalimumab (22; 31%) and Rituximab (17; 24%)]. Median [IQR] ILD duration up to BARI initiation was of
25 [13-63]
months.
Mean baseline values of FVC and DLCO (% predicted) were 86
±
28
and 69
±
20, respectively. Patients were followed-up for a median [IQR] of 14 [6-42] months. The evolution of FVC and DLCO remained stable during the first 24 months (Figure). At the end of the follow-up, available chest HRCT images improved/ stabilized
in 72% of patients. Stabilization or improvement of dyspnea was found in 90% of patients. Most patients showed articular remission or low activity. BARI was withdrawn in 32 (46%) patients due to articular inefficacy (n=22), lung inefficacy (n=5), development of hypersensitivity pneumonitis (n=1), ocular involvement (n=1), acute myocardial infarction (n=1), respiratory infection (n=1) and appearance of brain cancer (n=1).
Conclusion: BARI might be safe and useful in controlling both pulmonary and joint disease in RA-ILD patients.
Table. Baseline characteristics of RA-ILD patients treated with BARI.
Figure. Evolution of pulmonary function tests (mean % of the predicted FVC and DLCO) in RA-ILD patients with BARI therapy at baseline and 24 months.
A. Serrano-Combarro: None; B. Atienza-Mateo: None; J. Valero Jaimes: None; M. Pastor-Mena: None; R. Melero-Gonzalez: None; M. Martín López: None; S. Castañeda: Bristol-Myers Squibb(BMS), 2, 6, Eli Lilly, 2, 6, Merck/MSD, 2, 5, 6, Pfizer, 5, Roche, 2, 6, UCB, 2, 5; J. Loarce: None; C. Egües Dubuc: None; N. Mena Vázquez: None; C. Carrasco-Cubero: None; C. Perez-Garcia: None; J. Blanco Madrigal: None; N. Vegas Revenga: None; L. Pérez Albadalejo: None; R. Ortega-Castro: None; D. Palma: None; A. Fernández-Ortiz: None; M. López Lasanta: None; M. Garijo Bufort: None; I. Casafont-Sole: None; A. García-Valle: None; M. Martinez-Vidal: None; B. Flores Robles: None; E. CERVANTES PEREZ: None; I. Brana Abascal: None; S. Rojas Herrera: None; J. Sarmiento-Monroy: None; V. Ruiz-Esquide: None; J. LAMUA RIAZUELO: None; U. Astigarraga-Urquia: None; D. Ferrer: None; R. Blanco-Alonso: AbbVie, 2, 5, 6, Bristol-Myers Squibb, 2, 6, Galapagos, 6, Janssen, 2, 6, Lilly, 2, 6, MSD, 2, 5, 6, Pfizer, 2, 6, Roche, 2, 5, 6.