Druce Katie L, Iqbal Kundan, Watson Kath D, Symmons Deborah P M, Hyrich Kimme L, Kelly Clive
Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, UK.
RMD Open. 2017 Jul 13;3(1):e000473. doi: 10.1136/rmdopen-2017-000473. eCollection 2017.
Guidelines cautioned prescribing of tumour necrosis factor inhibitors (TNFi) to patients with rheumatoid arthritis and interstitial lung disease (RA-ILD) after reports of new or worsening of ILD. Less is known about outcomes among patients with RA-ILD who receive rituximab (RTX). This study compares mortality in patients with RA-ILD who received RTX or TNFi as their first biologic.
Participants with RA-ILD recruited to the British Society for Rheumatology Biologics Register for RA were included. Death rates were calculated and risk comparisons were made using Cox regression. Causes of death, including the frequency in which ILD was recorded on death certificates were examined.
43 patients on RTX and 309 on TNFi were included. RTX recipients had shorter disease duration and less disability. Death rates were 94.8 (95%CI: 74.4 to 118.7) and 53.0 (22.9 to 104.6) per 1000 person years, respectively. The adjusted mortality risk was halved in the RTX cohort, but the difference was not statistically significant (HR 0.53, 95% CI: 0.26 to 1.10). ILD was the underlying cause of death in 1 of 7 RTX deaths (14%) and 12 of 76 TNFi deaths (16%).
Patients with RA-ILD who received RTX had lower mortality rates compared to TNFi. The absence of information on ILD severity or subtype prevents conclusions of which drug represents the best choice in patients with RA-ILD and active arthritis.
有报告称类风湿关节炎合并间质性肺病（RA-ILD）患者出现新发或病情恶化的间质性肺病（ILD）后，指南对给此类患者开具肿瘤坏死因子抑制剂（TNFi）提出了警示。对于接受利妥昔单抗（RTX）治疗的RA-ILD患者的预后了解较少。本研究比较了接受RTX或TNFi作为首个生物制剂治疗的RA-ILD患者的死亡率。
纳入招募至英国风湿病学会类风湿关节炎生物制剂登记处的RA-ILD患者。计算死亡率，并使用Cox回归进行风险比较。检查死亡原因，包括死亡证明上记录ILD的频率。
纳入43例接受RTX治疗的患者和309例接受TNFi治疗的患者。接受RTX治疗的患者病程较短且残疾程度较轻。每1000人年的死亡率分别为94.8（95%CI：74.4至118.7）和53.0（22.9至104.6）。RTX队列中调整后的死亡风险减半，但差异无统计学意义（HR 0.53，95%CI：0.26至1.10）。7例RTX治疗死亡患者中有1例（14%）、76例TNFi治疗死亡患者中有12例（16%）的潜在死亡原因是ILD。
与TNFi相比，接受RTX治疗的RA-ILD患者死亡率较低。由于缺乏关于ILD严重程度或亚型的信息，无法得出哪种药物是RA-ILD合并活动性关节炎患者最佳选择的结论。
