Rare diseases

New evidence for abatacept in RA-ILD could be practice changing 


New evidence for the use of abatacept in the treatment of interstitial lung disease (ILD) associated with RA has the potential to be practice changing, rheumatologists say.

A multicentre observational study of 263 patients with RA-ILD has found stable or improved pulmonary function tests in ~90% of the patients who were treated with abatacept.

Furthermore, 77% had stable or improved radiologic findings and there was a clinically and statistically significant reduction in mean glucocorticoid dose from 7.5mg to 5mg daily.

Dr Elena Nikiphorou from the Centre for Rheumatic Diseases, King’s College London, and Dr Richard Conway from St. James’s Hospital, Trinity College, Dublin, said the findings “place it firmly in the current therapeutic algorithm.”

“Overall, these results are suggestive of a significant beneficial effect of abatacept in RA-ILD ,” they wrote in an editorial accompanying the study in the journal Rheumatology.

Acknowledging that the study had limitations, such as its observational nature, missing data and the lack of a control arm, the rheumatologists said the findings give out a strong message that is likely to be practice changing.

“The evidence base for the use of abatacept is now equivalent, if not superior, to that for rituximab … This is particularly important for centres that may have difficulties administering intravenous infusions due to lack of day-care beds or other facilities … there may be advantages in certain settings in terms of funding models,” they said.

“Abatacept has now joined rituximab as having a reasonable evidence base behind its use in RA-ILD. While these data are encouraging, we urgently need randomized controlled trial data to better inform treatment decisions in this area,” they added.

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