Tofacitinib tied to reduced incidence of ILD among Rheumatoid arthritis patients

Matthew C. Baker said that future prospective studies with tofacitinib to prevent RA-ILD should be considered.

Insufficient data and research are available on the risk of usage of biologic and targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) on developing interstitial lung disease (ILD) in RA patients.

Considering this background, researchers determined the risk of developing ILD in patients with RA undergoing treatment with different b/tsDMARDs in their respective cohort studies. They calculated Crude incidence rates (IRs) for developing ILD and compared ILD risk in adults with RA, one year or more of continuous enrollment, treatment with a b/tsDMARD of interest, and without preexisting ILD.

They used data from Optum Clinformatics Data Mart (December 2003-December 2019). The exposures in the study were the new administration of adalimumab, abatacept, rituximab, tocilizumab, and tofacitinib.

The results of the research study are:

• Twenty-eight thousand five hundred fifty-nine patients with RA mean age of 55.6 years were included.
• The number of patients treated with adalimumab, abatacept, rituximab, tocilizumab, and tofacitinib were 22 158, 13 326, 5676, 5444, 2548 patients and 1565, respectively.
• Crude IRs per 1000 person-years for ILD for adalimumab, abatacept, rituximab, tocilizumab, and tofacitinib were 3.43, 4.46, 6.15, 5.05, and 1.47, respectively.
• Patients treated with tofacitinib had a lower risk of ILD with aHR of 0.31.4
• Patients treated with tofacitinib had a 68% reduced risk of ILD than adalimumab with aHR 0.32.
• The risk was reduced by 69% of ILD in patients treated with tofacitinib than those treated with adalimumab.

Concluding further, they said among RA patients, those treated with tofacitinib had the lowest incidence of ILD. More research is required to understand how tofacitinib prevents ILD in patients with RA.

They also mentioned words of caution, saying results should be interpreted with caution due to the relatively small sample size of the tofacitinib group.

Further reading:

Baker MC, Liu Y, Lu R, Lin J, Melehani J, Robinson WH. Incidence of Interstitial Lung Disease in Patients With Rheumatoid Arthritis Treated With Biologic and Targeted Synthetic Disease-Modifying Antirheumatic Drugs. JAMA Netw Open. 2023;6(3):e233640. doi:10.1001/jamanetworkopen.2023.3640