scholarly journals Tofacitinib for the Treatment of Severe Interstitial Lung Disease Related to Rheumatoid Arthritis

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Caterina Vacchi ◽  
Andreina Manfredi ◽  
Giulia Cassone ◽  
Stefania Cerri ◽  
Giovanni Della Casa ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Kinase Inhibitors ◽  
Therapeutic Option ◽  
Real Life ◽  
Janus Kinase ◽  
Joint Involvement ◽  
Infectious Risk ◽  
Systemic Inflammatory Disease

Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterized by chronic symmetrical erosive synovitis and extra-articular manifestations, including interstitial lung disease (ILD), whose treatment is nowadays challenging due to high infectious risk and possible pulmonary iatrogenic toxicity. Janus kinase inhibitors, namely, tofacitinib, baricitinib, and upadacitinib, are the latest drug class for the treatment of RA with a good safety profile. We present the case of a patient with RA-ILD successfully treated with tofacitinib. A 52-year-old man was referred to our multidisciplinary clinic for rheumatic and pulmonary diseases for an active erosive seropositive RA and progressive ILD. Previous treatments were GC, hydroxychloroquine, methotrexate, etanercept, withdrawn after ILD detection, and tocilizumab, discontinued due to relapsing infections. After our evaluation, we proposed rituximab in addition to low-dose GC and hydroxychloroquine, ineffective on joint involvement. Therefore, we proposed tofacitinib which allowed us to control joint involvement, stabilize ILD improving respiratory symptoms, and manage the frequent infectious episodes that occurred initially. The short half-life and rapid-acting of tofacitinib are two helpful characteristics regarding this aspect. Despite limited data from randomized trials and real-life, tofacitinib could represent a safe therapeutic option for RA-ILD patients. Longitudinal studies are required to confirm this encouraging report.

scholarly journals Combination Therapy with Nintedanib and Sarilumab for the Management of Rheumatoid Arthritis Related Interstitial Lung Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-4 ◽  
Author(s):  
Caterina Vacchi ◽  
Andreina Manfredi ◽  
Giulia Cassone ◽  
Carlo Salvarani ◽  
Stefania Cerri ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Interstitial Lung Disease ◽  
Combination Therapy ◽  
Lung Disease ◽  
Therapeutic Approach ◽  
Negative Impact ◽  
Case Series ◽  
Joint Involvement ◽  
Sustained Remission ◽  
Systemic Inflammatory Disease

Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease characterized by joint and extra-articular involvement. Among them, interstitial lung disease (ILD) is one of the most common and severe extra-articular manifestations, with a negative impact on both therapeutic approach and overall prognosis. ILD can occur at any point of the natural history of RA, sometimes before the appearance of joint involvement. Since no controlled studies are available, the therapeutic approach to RA-ILD is still debated and based on empirical approaches dependent on retrospective studies and case series. Here, we report the case of a 75-year-old patient affected by RA complicated by ILD successfully treated with a combination therapy of an antifibrotic agent, nintedanib, and an inhibitor of IL-6 receptor, sarilumab. We obtained a sustained remission of the joint involvement and, simultaneously, a stabilization of the respiratory symptoms and function, with a good safety profile. To date, this is the first report describing a combination therapy with nintedanib and a disease-modifying antirheumatic drug (DMARD) for the management of RA complicated by ILD. Future prospective studies are needed to better define efficacy and safety of this approach in the treatment of these subjects.

Nintedanib for the treatment of refractory progressive rheumatoid arthritis–related interstitial lung disease: a real-life case series

Rheumatology ◽  
2020 ◽  
Vol 59 (12) ◽  
pp. 3983-3986
Author(s):  
Javier Narváez ◽  
Vanesa Vicens-Zygmunt ◽  
Juan-José Alegre ◽  
Silvia Herrera-Lara ◽  
Joan-Miquel Nolla ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Real Life ◽  
Case Series

scholarly journals Cardiovascular risk comorbidities in rheumatoid arthritis patients and the use of anti-rheumatic drugs: a cross-sectional real-life study

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Gustavo Nogueira Schincariol Vicente ◽  
Ivânio Alves Pereira ◽  
Gláucio Ricardo Werner de Castro ◽  
Licia Maria Henrique da Mota ◽  
Ana Paula Carnieletto ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Risk ◽  
Cardiovascular Event ◽  
Real Life ◽  
Treatment Strategies ◽  
Joint Involvement ◽  
Cross Sectional ◽  
Cardiovascular Comorbidity ◽  
Cardiovascular Comorbidities ◽  
Systemic Inflammatory Disease

Abstract Background Rheumatoid arthritis (RA) is a common autoimmune systemic inflammatory disease. In addition to joint involvement, RA patients frequently have other comorbidities, such as cardiovascular diseases. Drugs used for RA treatment may increase or decrease the risk of a cardiovascular event. This study aims to analyze cardiovascular risk comorbidities in patients with RA and the correlation with the use of anti-rheumatic drugs. Methods Cross-sectional study conducted based on the real-life rheumatoid arthritis study database – REAL, a prospective observational cohort study. Associations between the use of anti-rheumatic drugs and the presence of comorbidities were represented by their prevalence ratio and evaluated using the Chi-square or Fisher’s Exact tests. Results We assessed 1116 patients, 89.4% women, mean age of 55.15 years and predominance of seropositive disease. 63.3% had some cardiovascular comorbidity, predominantly hypertension (49.9%). The use of glucocorticoids was observed in 47.4% of patients and there was a significant tendency of lower use of these drugs in the presence of dyslipidemia (PR: 0.790; p = 0.007). We observed that the presence of cardiovascular comorbidities was associated with higher use of bDMARDs (PR:1.147; p = 0.003). Conclusions The presence of cardiovascular risk comorbidities was confirmed to be higher in RA patients. Different treatment strategies using less glucocorticoids in the presence of dyslipidemia and more common use of bDMARDs in patients with cardiovascular comorbidities suggest that rheumatologists are aware of the potential influence of the DMARDs in the risk of cardiovascular event. Reinforcing these results, we highlight the need for a better baseline assessment to guide the choice of anti-rheumatic drugs in RA patients who have comorbidities.

scholarly journals JAK-Inhibitors for the Treatment of Rheumatoid Arthritis: A Focus on the Present and an Outlook on the Future

Biomolecules ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. 1002 ◽  
Author(s):  
Jacopo Angelini ◽  
Rossella Talotta ◽  
Rossana Roncato ◽  
Giulia Fornasier ◽  
Giorgia Barbiero ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Safety Profile ◽  
Kinase Inhibitors ◽  
Case Reports ◽  
Real Life ◽  
Rapid Onset ◽  
Janus Kinase ◽  
Efficacy And Safety ◽  
Biological Drugs ◽  
Disease Modifying Drugs

Janus kinase inhibitors (JAKi) belong to a new class of oral targeted disease-modifying drugs which have recently revolutionized the therapeutic panorama of rheumatoid arthritis (RA) and other immune-mediated diseases, placing alongside or even replacing conventional and biological drugs. JAKi are characterized by a novel mechanism of action, consisting of the intracellular interruption of the JAK-STAT pathway crucially involved in the immune response. The aim of this narrative review is to globally report the most relevant pharmacological features and clinical outcomes of the developed and incoming JAKi for RA, based on the available preclinical and clinical evidence. A total of 219 papers, including narrative and systematic reviews, randomized controlled trials (RCTs), observational studies, case reports, guidelines, and drug factsheets, were selected. The efficacy and safety profile of both the first generation JAKi (baricitinib and tofacitinib) and the second generation JAKi (upadacitinib, filgotinib, peficitinib, decernotinib and itacitinib) were compared and discussed. Results from RCTs and real-life data are encouraging and outline a rapid onset of the pharmacologic effects, which are maintained during the time. Their efficacy and safety profile are comparable or superior to those of biologic agents and JAKi proved to be efficacious when given as monotherapy. Finally, the manufacturing of JAKi is relatively easier and cheaper than that of biologics, thus increasing the number of compounds being formulated and tested for clinical use.

scholarly journals Efficacy and safety of tofacitinib in rheumatoid arthritis-associated interstitial lung disease: TReasure real-life data

2021 ◽  
Author(s):  
Umut Kalyoncu ◽  
Emre Bilgin ◽  
Abdulsamet Erden ◽  
Hasan Satış ◽  
Abdurrahman Tufan ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Pulmonary Function Tests ◽  
Real Life ◽  
Post Treatment ◽  
Retention Rates ◽  
Control Group ◽  
Efficacy And Safety

Abstract Background/Aim: Rheumatoid arthritis associated interstitial lung disease (RA-ILD) is a major concern in RA patients and events of ILD have been reported in patients treated with tofacitinib in RA clinical trials and in the post-marketing setting. The aim of this study was to assess the real-life efficacy and safety of tofacitinib in patients with RA-ILD. Methods RA patients with ILD diagnosis based on the HRCT images of the lungs from eight different centers recruited to study. As a control group, RA patients without ILD under tofacitinib was included. Demographic data, patients’ characteristics, available pulmonary function tests regarding RA and RA-ILD at the visit in which tofacitinib was initiated and for the last follow-up visit under tofacitinib were recorded. Reasons of tofacitinib discontinuation were also recorded. Drug retention rates were compared by log-rank test. p value < 0.05 was considered statistically significant. Results A total of 47 (42.6% male) RA patients with RA-ILD and a control group of 387 (17.8 % male) patients without RA-ILD were included in the analysis. After the median of 12 (9–19) months follow-up period, mean FEV1%; 82.1 vs. 82.8 (pre and post-treatment, respectively, p = 0.079), mean FVC%; 79.8 vs. 82.8 (pre and post-treatment, respectively, p = 0.014) were stable and worsening was observed 2/18 (11.1%) patients. Retention rates were similar (p = 0.21, log-rank). In RA-ILD group, most common cause of drug discontinuation was infections (6.3 vs 2.4 per 100 patient-years). Conclusion The treatment strategy of RA-ILD patients are still based on small observational studies. High rate of discontinuation due infections was observed in RA-ILD patients under tofacitinib; however, RA-ILD patients were older than RA patients without ILD.

scholarly journals Correlation between Lung and Joint Involvement in Patients with Rheumatoid Arthritis and Interstitial Lung Disease: A Cross-Sectional Study

2018 ◽  
Vol 70 (2) ◽  
Author(s):  
Francisco Paulin ◽  
Juan Mercado ◽  
Martín Eduardo Fernández ◽  
Fabián Caro ◽  
María Laura Alberti ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Cross Sectional Study ◽  
Joint Involvement ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Lights and Shadows

2020 ◽  
Vol 9 (4) ◽  
pp. 1082 ◽  
Author(s):  
Giulia Cassone ◽  
Andreina Manfredi ◽  
Caterina Vacchi ◽  
Fabrizio Luppi ◽  
Francesca Coppi ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Research Agenda ◽  
Pulmonary Toxicity ◽  
Pulmonary Complication ◽  
Systemic Inflammatory Disease ◽  
Synthetic Dmards ◽  
Therapeutic Recommendations ◽  
Antifibrotic Agents

Rheumatoid arthritis (RA) is a chronic and systemic inflammatory disease affecting 0.5–1% of the population worldwide. Interstitial lung disease (ILD) is a serious pulmonary complication of RA and it is responsible for 10–20% of mortality, with a mean survival of 5–8 years. However, nowadays there are no therapeutic recommendations for the treatment of RA-ILD. Therapeutic options for RA-ILD are complicated by the possible pulmonary toxicity of many disease modifying anti-rheumatic drugs (DMARDs) and by their unclear efficacy on pulmonary disease. Therefore, joint and lung involvement should be evaluated independently of each other for treatment purposes. On the other hand, some similarities between RA-ILD and idiopathic pulmonary fibrosis and the results of the recent INBIULD trial suggest a possible future role for antifibrotic agents. From this perspective, we review the current literature describing the pulmonary effects of drugs (immunosuppressants, conventional, biological and target synthetic DMARDs and antifibrotic agents) in patients with RA and ILD. In addition, we suggest a framework for the management of RA-ILD patients and outline a research agenda to fill the gaps in knowledge about this challenging patient cohort.

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