Andreina Manfredi1, Giulia Cassone1,2,3, Federica Furini4, Elisa Gremese5, Vincenzo Venerito6, Fabiola Atzeni7, Eugenio Arrigoni8, Giovanni Della Casa9, Stefania Cerri10, Marcello Govoni4, Luca Petricca5, Florenzo Iannone6, Carlo Salvarani1,3, Marco Sebastiani1. 1. Rheumatology Unit, University of Modena and Reggio Emilia, Univeritary Hospital Policlinico of Modena, Modena, Italy. 2. Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy. 3. Rheumatology Unit, IRCCS Arcispedale Santa Maria Nuova, Universitary Hospital Policlinico of Modena, Reggio Emilia, Italy. 4. Department of Medical Sciences, Division of Rheumatology, Santa Anna University Hospital, Ferrara, Italy. 5. Division of Rheumatology, Institute of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy. 6. Rheumatology Unit, University of Bari, Bari, Italy. 7. Rheumatology Unit, University of Messina, Messina, Italy. 8. Rheumatology Unit, ERI Medicine, Hospital of Piacenza, Piacenza, Italy. 9. Radiology Unit, Universitary Hospital Policlinico of Modena, Modena, Italy. 10. Respiratory Disease Unit, University of Modena and Reggio Emilia, Universitary Hospital Policlinico of Modena, Modena, Italy.
Abstract
BACKGROUND: Interstitial lung disease (ILD) is the most severe extra-articular manifestation of rheumatoid arthritis (RA). Although it is responsible of 10-20% of all RA mortality, no controlled studies are available for the treatment of RA-ILD and its therapeutic approach is still debated. AIMS: To analyse the evolution of ILD in a population of RA patients treated with tocilizumab (TCZ). METHODS: In this national multicentre study, we retrospectively collected patients with RA-ILD treated with at least one dose of TCZ. For each patient, disease activity and serological data were evaluated. Moreover, we analysed the evolution of high-resolution computed tomography (HRCT) and pulmonary function tests, including forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO). RESULTS: Twenty-eight RA-ILD patients were identified (females/males 18/10, mean age 61.6 years), with a mean follow up for TCZ therapy of 30 months. At the end of follow up, FVC remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%). DLCO remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%), even though in 3 patients DLCO and FVC showed an opposite trend. HRCT remained stable in the majority (25) of cases, worsened in two patients with a usual interstitial pneumonia pattern and improved in only one case with a non-specific interstitial pneumonia pattern. CONCLUSIONS: The management of RA-ILD patients remains a critical unmet need. TCZ demonstrated a good safety profile in patients with RA-ILD and a potential effect on the stabilisation of lung involvement.
BACKGROUND:Interstitial lung disease (ILD) is the most severe extra-articular manifestation of rheumatoid arthritis (RA). Although it is responsible of 10-20% of all RA mortality, no controlled studies are available for the treatment of RA-ILD and its therapeutic approach is still debated. AIMS: To analyse the evolution of ILD in a population of RA patients treated with tocilizumab (TCZ). METHODS: In this national multicentre study, we retrospectively collected patients with RA-ILD treated with at least one dose of TCZ. For each patient, disease activity and serological data were evaluated. Moreover, we analysed the evolution of high-resolution computed tomography (HRCT) and pulmonary function tests, including forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO). RESULTS: Twenty-eight RA-ILDpatients were identified (females/males 18/10, mean age 61.6 years), with a mean follow up for TCZ therapy of 30 months. At the end of follow up, FVC remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%). DLCO remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%), even though in 3 patients DLCO and FVC showed an opposite trend. HRCT remained stable in the majority (25) of cases, worsened in two patients with a usual interstitial pneumonia pattern and improved in only one case with a non-specific interstitial pneumonia pattern. CONCLUSIONS: The management of RA-ILDpatients remains a critical unmet need. TCZ demonstrated a good safety profile in patients with RA-ILD and a potential effect on the stabilisation of lung involvement.
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