Association of Anti-Ro52 Seropositive Interstitial Lung Disease With a Higher Risk of Disease Progression and Mortality.

BACKGROUND

Identifying biomarkers is vital for interstitial lung disease (ILD) management and prognostication. Although anti-Ro52 antibodies frequently are detected in autoimmune diseases, their significance in ILD remains unclear.

RESEARCH QUESTION

What is the prognostic significance of anti-Ro52 antibody positivity in patients with ILD?

STUDY DESIGN AND METHODS

This retrospective cohort study used an ILD registry of patients seen at an academic tertiary hospital's ILD clinic between 2015 and 2024. All patients with a diagnosis of ILD and tested for anti-Ro52 antibody status were divided into anti-Ro52 positive and negative groups. The primary outcome was ILD progression or all-cause death. ILD progression was defined as any of the following: hospitalization because of ILD, absolute decline in FVC of ≥ 10% predicted from baseline, or lung transplantation. The Kaplan-Meier method and Cox proportional hazards regression model were used for survival analysis.

RESULTS

Of 1,026 patients tested for the anti-Ro52 antibody (median age, 70 years; 52% male), 154 patients (15%) showed positive anti-Ro52 results. Underlying ILD subtypes were as follows: interstitial pneumonia with autoimmune features (n = 489 [48%]), connective tissue disease-associated ILD (n = 132 [13%]), idiopathic pulmonary fibrosis (n = 103 [10%]), hypersensitivity pneumonitis (n = 61 [6%]), and other idiopathic ILD (n = 241 [24%]). The anti-Ro52-positive group was younger (median age, 67 years vs 70 years), was more likely to have connective tissue disease (28% vs 10%), and more frequently showed copositive results for myositis-specific antibody (29% vs 16%). After a median follow-up of 25.6 months, patients with positive anti-Ro52 findings showed a higher risk of ILD progression or death (hazard ratio, 2.10; 95% CI, 1.61-2.73; P < .001) and showed a higher risk of lung transplantation or death (hazard ratio, 1.61; 95% CI, 1.11-2.35; P = .014) on multivariable analysis.

INTERPRETATION

Our results indicate that Anti-Ro52-seropositive ILD is associated with significantly worse progression-free and transplant-free survival and may inform disease prognostication and monitoring.