Institute of Medicine, Chung Shan Medical University, South District, No. 110, Section 1, Jianguo North Road, 402, Taichung, Taiwan.
Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Changhua Christian Hospital, No. 135, NanXiao Street, 500, Changhua, Taiwan.
Clin Exp Med. 2024 Aug 12;24(1):186. doi: 10.1007/s10238-024-01448-3.
Rheumatoid arthritis is a chronic inflammatory disease, and interstitial lung disease is one of the important extra-articular manifestations. There is limited evidence comparing abatacept (ABA) and tumor necrosis factor inhibitors (TNFi) regarding the risk of mortality among patients with rheumatoid arthritis associated interstitial lung disease (RA-ILD). The aim of this study is to investigate the risk of mortality in patients with RA-ILD treated with ABA compared to TNFi. This retrospective cohort study utilized TriNetX electronic health record database. We enrolled patients who were diagnosed with RA-ILD and had received a new prescription for either ABA or TNFi. Patients were categorized into two cohorts based on their initial prescription. The primary outcome was all-cause mortality, and secondary outcomes were healthcare utilizations, including hospitalization, critical care services, and mechanical ventilation. Subgroup analyses were performed on age, presence of anti-citrullinated peptide antibodies (ACPA), and cardiovascular risk. Among 34,388 RA-ILD patients, 895 were selected for each group (ABA and TNFi) following propensity score matching. The ABA group exhibited a higher all-cause mortality risk. (HR 1.296, 95% CI 1.006-1.671). Subgroup analysis showed a heightened risk of receiving mechanical ventilation in ABA-treated patients aged 18-64 years old (HR 1.853, 95% CI 1.002-3.426), and those with cardiovascular risk factors (HR 2.015, 95% CI 1.118-3.630). Another subgroup analysis indicated a higher risk of mortality among ABA-treated patients with positive-ACPA. (HR 4.138 95% CI 1.343-12.75). This real-world data research demonstrated a higher risk of all-cause mortality in RA-ILD patients treated with ABA compared to TNFi, particularly those aged 18-64 years, lacking cardiovascular risk factors, and positive-ACPA. ABA was associated with an increased risk of mechanical ventilation in patients aged 18-64 years and those with cardiovascular risk factors.
类风湿关节炎是一种慢性炎症性疾病，间质性肺疾病是重要的关节外表现之一。目前关于类风湿关节炎相关间质性肺疾病（RA-ILD）患者中，阿巴西普（ABA）和肿瘤坏死因子抑制剂（TNFi）的死亡率风险比较，证据有限。本研究旨在调查 RA-ILD 患者接受 ABA 治疗与 TNFi 治疗相比的死亡率风险。这项回顾性队列研究使用了 TriNetX 电子健康记录数据库。我们纳入了被诊断为 RA-ILD 且新处方为 ABA 或 TNFi 的患者。根据初始处方将患者分为两组。主要结局是全因死亡率，次要结局是医疗保健利用情况，包括住院、重症监护服务和机械通气。在年龄、抗瓜氨酸肽抗体（ACPA）存在和心血管风险方面进行了亚组分析。在 34388 名 RA-ILD 患者中，根据倾向评分匹配后，每组（ABA 和 TNFi）各选择 895 名患者。ABA 组全因死亡率风险更高。（HR 1.296，95% CI 1.006-1.671）。亚组分析显示，18-64 岁接受 ABA 治疗的患者机械通气风险升高（HR 1.853，95% CI 1.002-3.426），且存在心血管危险因素的患者（HR 2.015，95% CI 1.118-3.630）。另一项亚组分析表明，ACPA 阳性的 ABA 治疗患者死亡风险更高。（HR 4.138，95% CI 1.343-12.75）。这项真实世界数据研究表明，与 TNFi 相比，RA-ILD 患者接受 ABA 治疗的全因死亡率风险更高，尤其是 18-64 岁、无心血管危险因素和 ACPA 阳性的患者。ABA 与 18-64 岁患者和有心血管危险因素的患者机械通气风险增加相关。
