NON-TNFI B/TSDMARDS VS. TNFI IN RHEUMATOID ARTHRITIS-INTERSTITIAL LUNG DISEASE: AN ACTIVE-COMPARATOR, NEW-USER, PROPENSITY SCORE MATCHED STUDY USING NATIONAL VETERANS AFFAIRS DATA
Authors: Bryant England et al.
This is a real-world pharmacoepidemiologic study of second-line antirheumatic therapies (TNFi versus non-TNFi/JAKi ) in patients with RA and interstitial lung disease (RA-ILD). The authors included RA patients with ILD initiating TNFi or non-TNFi biologic/JAKi in an American military cohort (VA). The authors used a method called ‘Target Trial Emulation framework’ to analyse the data. 237 TNFi initiators were matched to 237 non-TNFi/JAKi initiators. Adalimumab (51%) and etanercept (37%) were the most frequent TNFi, while rituximab (53%) and abatacept (28%) were the most frequent non-TNFi/JAKi. Overall, there was no significant difference in the time to respiratory-related hospitalization or death between non-TNFi/JAKi vs. TNFi (aHR 1.22 [0.92, 1.60]), or in respiratory hospitalization, all-cause mortality, or respiratory-related death.
Older studies had reported higher mortality with TNFi in patients with RA-ILD, which has led to avoidance of TNFi in in these patients. While there is still not much data to help clinicians chose between various bDMARDs and JAKi in RA-ILD patients, this report did not observe significant differences in the risk of respiratory hospitalization or death between patients initiating TNFi versus non-TNFi/JAKi. Overall, these results do not support systematic avoidance of TNFi in RA-ILD.