Rituximab Lowers Death Risk in RA Patients With Lung Conditions?

When rheumatoid arthritis (RA) patients are unfortunate enough to also have lung problems, they can be at an increased risk of mortality. First-line therapy with rituximab (RTX), says a new study from the UK, may help them live longer when compared with the use of tumor necrosis factor inhibitors (TNFi).

“Treatment of the underlying arthritis among patients with RA-ILD [interstitial lung disease] can be complicated, as methotrexate is often contraindicated, ” said Kimme Hyrich, M.D., Ph.D., FRCPC, professor of Epidemiology and honorary consultant in Rheumatology at the Arthritis Research UK Centre for Epidemiology at the University of Manchester, in the November 12, 2016 news release. “It’s been unclear what the best choice of biologic therapy is for patients with RA-ILD and active arthritis given the relative contraindication for TNFi.”

As indicated in the news release, “The study’s aim was to analyze and compare mortality rates among patients with RA-ILD who had started either rituximab or TNFi as their first biologic, including causes of death. The researchers examined mortality data on participants in the British Society for Rheumatology Biologics Register for RA…The researchers concluded that the unadjusted mortality risk in patients treated with RTX was numerically half of the risk found in patients treated with TNFi, although this was not statistically significant. Adjustment for baseline age, sex, disability, disease activity and disease duration had little effect on these estimates.”

“The main message is that the death rates among patients with RA-ILD who started RTX as their first biologic were lower compared to patients who started a TNFi. We did adjust our analysis for age, gender, disease duration and HAQ [Health Assessment Questionnaire], which did differ between the two cohorts and are important risk factors themselves for mortality, ” said Dr. Hyrich. “However, because we did not have data on the severity of the lung disease itself, which is also an important risk factor for mortality, it is unfortunately difficult to say with certainty that RTX is a better option for patients with RA-ILD in the absence of clinical trial data.”

Dr. Hyrich told OTW, “It was interesting to observe the lower mortality in patients receiving RTX compared to TNFi, although this may represent better survival overall in patients diagnosed in more recent years rather than a specific benefit of RTX. This finding was also supported by the finding of no difference in the proportion of patients whose underlying cause of death was due to RA-ILD. We still observed deaths from ILD among patients receiving RTX. The higher death rates among TNfi were across all causes of deaths and not specific to any one cause, suggesting that the TNFi did not immediately lead to this higher death rate.”

“Orthopedic surgeons should be aware of whether their patients have ILD as they may have worse health outcomes, including increased mortality regardless of treatment.”