Patients with rheumatoid arthritis (RA) who also have lung involvement often have increased mortality, but first-line therapy with Rituxan® (rituximab) may help them live longer when compared with the use of tumor necrosis factor inhibitors (TNFi), according to new research findings presented at the 2016 ACR/ARHP Annual Meeting in Washington, DC.
Rheumatoid arthritis is a chronic inflammatory disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men. Although joints are the principal body parts affected by RA, inflammation can develop in other organs as well.
People with RA have a higher risk of lung disease than the general population, and smoking further increases this risk. RA involvement of the lungs causes interstitial lung disease (ILD), which is associated with increased mortality. Interstitial lung disease refers to a group of lung disorders that cause scarring of the lungs. As these disorders worsen, it can become increasingly difficult to breathe and to get enough oxygen into the body. Interstitial lung disease is more common among people with RA than among people in the general population.
Some research has suggested that treatment of RA with TNFi may be linked to the development or worsening of ILD. In 2005, the British Society for Rheumatology actually advised against using TNFi in patients with ILD, but did not make a recommendation concerning the use of Rituxan. In order to evaluate whether Rituxan could benefit patients with RA and ILD, British researchers designed a clinical study to analyze and compare mortality rates among patients with RA-ILD who had started therapy with either Rituxan or a TNFi as their first biologic therapy.
Overall, 353 RA patients were identified in a British registry that also had ILD. Forty-three of these patients were treated with Rituxan and 310 were treated with a TNFi. The researchers determined that the overall mortality risk for the Rituxan treated patients was approximately half that observed in the RA patients treated with a TNFi.
The main message from this study is that the death rates among patients with RA-ILD who started Rituxan as their first biologic therapy was lower compared to patients who started a TNFi.
“Key to understanding this issue further will be a greater collection of data from patients with this history either separate to or within national registries. This is a rare condition, and without robust studies, guidance on the best choice of therapy to treat the underlying arthritis will remain limited to anecdotal evidence.”