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2017 ; 3
(1
): e000473
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
Mortality in patients with interstitial lung disease treated with rituximab or
TNFi as a first biologic
#MMPMID28955489
Druce KL
; Iqbal K
; Watson KD
; Symmons DPM
; Hyrich KL
; Kelly C
RMD Open
2017[]; 3
(1
): e000473
PMID28955489
show ga
OBJECTIVES: 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. METHODS: 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.
RESULTS: 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%).
CONCLUSIONS: 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.