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24-01-2025 | Rheumatoid Arthritis | Editor's Choice | News

Data do not support systematic TNF inhibitor avoidance in RA-associated ILD

Author: Laura Cowen

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medwireNews: The rates of respiratory hospitalization and death do not differ significantly between people with rheumatoid arthritis (RA)-associated interstitial lung disease (ILD) treated with tumor necrosis factor (TNF) inhibitors and those given other treatments, real-world study data show.

Writing in The Lancet Rheumatology, Bryant England (University of Nebraska Medical Center, Omaha, USA) and colleagues say that their results “do not suggest that TNF inhibitors need to be systematically avoided in all patients with rheumatoid arthritis-associated ILD, refuting previous studies that suggested TNF inhibitors are associated with poorer outcomes.”

The add that this “is important because TNF inhibitors are the most commonly prescribed biological DMARD [disease-modifying antirheumatic drug] in patients with rheumatoid arthritis and are highly efficacious for improving articular disease activity and functional status, which are independent predictors of survival in rheumatoid arthritis-associated ILD.”

Using US Department of Veterans Affairs data, England and team identified 237 patients with RA-associated ILD who initiated TNF inhibitors such as etanercept, adalimumab, infliximab, certolizumab, or golimumab between 2006 and 2018.

These patients were propensity score matched to 237 patients with RA-associated ILD who initiated a non-TNF inhibitor biologic or targeted synthetic DMARD, including tocilizumab, sarilumab, abatacept, rituximab, tofacitinib, baricitinib, or upadacitinib, during the same period. Matching was based on demographics, healthcare use, health behaviors, comorbidity burden, disease severity, and time period to account for temporal trends in prescribing. Overall, patients had a mean age of 68 years and 92% were men.

The researchers report that, during 3 years of follow-up, 102 (43%) patients in the TNF inhibitor group and 112 (47%) of those in the non-TNF inhibitor group met the composite outcome of death or respiratory hospitalization.

The difference between the two groups was not statistically significant and there were also no significant differences with versus without TNF inhibitors for the individual outcomes of all-cause mortality (29 vs 31%), respiratory-related mortality (9 vs 12%), and respiratory hospitalization (28 vs 34%).

Furthermore, England and team observed similar results when they compared TNF inhibitors with rituximab, and when they stratified patients by age, or by previous biologic or targeted synthetic DMARDs use.

They say that, although the findings do not suggest systematic avoidance of TNF inhibitors in all patients with RA-associated ILD, disease heterogeneity and imprecise estimates in the current study may mean that “some subpopulations of patients with rheumatoid arthritis-associated ILD might benefit from specific biological or targeted synthetic DMARD treatment strategies.”

In an accompanying comment, Gregory McDermott and Jeffrey Sparks, both from the Brigham and Women’s Hospital and Harvard Medical School in Boston, Massachusetts, USA, say that the study “sheds light on the comparative safety of biological or targeted synthetic DMARDs in patients with rheumatoid arthritis-associated ILD and could provide reassurance on the safety of TNF inhibitors.”

However, they add: “Clinical trials are needed to confirm these findings and investigate the complex interplay between rheumatoid arthritis disease activity, medications, and rheumatoid arthritis-associated ILD outcomes.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2025 Springer Healthcare Ltd, part of the Springer Nature Group

Lancet Rheumatol 2025; doi:10.1016/S2665-9913(24)00265-0
Lancet Rheumatol 2025; doi:10.1016/S2665-9913(24)00337-0

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