Rituximab May Reduce Mortality Risk in Rheumatoid Lung Disease Save

While it is known that rheumatoid arthritis (RA) patients with interstitial lung involvement is associated with severe seropositive disease and is associated with an increased mortality. Unfortunately, there are no trials designed to address this issue and historic data fails to show that any proven therapies can deter such adverse outcomes.

An abstract presented by Hyrich et al at the 2016 ACR showed that first-line therapy with rituximab (RTX) may lead to reduced mortality when compared to those using TNF inhibitors (Citation source http://buff.ly/2hu2ioh).

In 2005, the British Society for Rheumatology advised against using TNF inhibitors (TNFi) in patients with RA and ILD, because of a lack of response and suggestions that some patients may worsen.

The BSRBR initiated a study to examine the 5 years mortality in RA-ILD patients therapy with either RTX or TNFi.

353 RA patients with RA-ILD, were treated with TNFi (n=310) or RTX (43). With 5 years of follow-up,  there were fewer deaths in the RTX vs TNFi cohorts 51.0 vs 94.4 per 1000 pyrs, respectively. The unadjusted mortality risk in the RTX treated patients was numerically half that in the TNFi treated patients, although this was not statistically significant (HR 0.51, 95%CI 0.25-1.06; Figure 1). Adjustment for baseline age, sex, disability, disease activity, and disease duration did not affect the outcomes.

The researchers concluded that the mortality risk in patients treated with RTX was numerically half of the risk found in patients treated with TNFi.  The registry data did not provide enough information on disease severity or ILD subtypes among these patients, so it was difficult to draw conclusions on the relative safety of these two therapies. In the future, larger and more detailed studies may help clarify safety issues for these therapies in this high-risk patient population.