Protective effects of tofacitinib against interstitial lung disease in RA patients

The findings of a recent retrospective cohort study have noted that tofacitinib outperformed several other biologics and synthetic disease-modifying antirheumatic drugs (sDMARDs) with the lowest incidence of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA). The study was published in the recent issue of JAMA Network Open.

According to Dr. Matthew C. Baker and co-authors, the crude incidence rate per 1,000 person-years for ILD among over 28,000 RA patients was lowest with the Janus kinase inhibitor tofacitinib. The study included 28,559 RA patients who were treated with adalimumab abatacept, rituximab, tocilizumab, or tofacitinib. The crude incidence rates per 1000 person-years for ILD were 3.43, 4.46, 6.15, 5.05, and 1.47 for adalimumab, abatacept, rituximab, tocilizumab, and tofacitinib respectively. When compared to patients treated with adalimumab, a lower risk of ILD (P=0.09) was reported in patients treated with tofacitinib. The study highlighted a 68% lower risk of ILD in patients who received tofacitinib compared to those on adalimumab (P<0.001). Besides, patients treated with tofacitinib had a 69% lower risk of ILD in an adjusted model than individuals treated with adalimumab.

A 2021 post-hoc analysis also reported the incidence rates for ILD events following tofacitinib treatment and the risk factors for ILD in RA patients. The analysis of 7061 patients reported the incidence rates for ILD with tofacitinib 5 or 10 mg as 0.18 per 100 patient years. Additionally, the study identified several risk factors for ILD events, including age ≥65 or older (hazard ratio [HR] 2.43), current smokers (HR 2.89), and Disease Activity Score in 28 joints-erythrocyte sedimentation rate score (HR 1.30). This study highlighted the significance of identifying the risk factors of RA-ILD in clinical practice.

Tofacitinib may be useful for avoiding ILD in RA patients, However, further prospective studies are required to corroborate the long-term safety and efficacy of tofacitinib before recommending as a definitive treatment option for preventing ILD in RA patients.

References

  1. 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 Network Open. 2023 Mar 1;6(3):e233640.
  2. Citera G, Mysler E, Madariaga H, Cardiel MH, Castañeda O, Fischer A, et al. Incidence rates of interstitial lung disease events in tofacitinib-treated rheumatoid arthritis patients: post hoc analysis from 21 clinical trials. Journal of Clinical Rheumatology. 2021 Dec;27(8):e482.
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