The majority of patients with rheumatoid arthritis (RA)-associated bronchiectasis treated with rituximab have a satisfactory safety profile, with either stable or improved pulmonary symptoms over a 10-year follow-up, according to findings published in Rheumatology. Researchers also found that discontinuation rates due to adverse lung outcomes were better with rituximab than those in a matched cohort of patients treated with tumor necrosis factor inhibitors (TNFis).
To evaluate the effects of rituximab on RA-associated bronchiectasis and compare 5-year respiratory survival rates between patients treated with rituximab and those treated with TNFis, investigators conducted a retrospective longitudinal cohort study of consecutive adult patients with RA-associated bronchiectasis from 2 medical centers in the United Kingdom over 10 years. Respiratory survival was defined as the time from initiation of therapy to discontinuation due to lung exacerbation or to respiratory-related death.
Of the 800 individuals with RA who received rituximab, 68 had RA-associated bronchiectasis (8.5%). The median duration (interquartile range) of response for cycles 1 through 3 were 54 weeks (46-68 weeks), 50 weeks (40-64 weeks), and 52 weeks (46-60 weeks), respectively. Before cycle 1 of rituximab, 22 of these 68 patients had either inadequate response or intolerance to TNFis.
At 12 months after the first cycle of rituximab, 31% of patients had fewer exacerbations than in the year prior to therapy, 53% remained stable, and 16% had increased exacerbations. No significant difference was seen in the median number of infective exacerbations before and after the initial cycle of rituximab (P =.105). Exacerbation rates improved after treatment cycle 2 and stabilized up to 5 cycles. Of the 60 patients who received ≥2 cycles of rituximab, 7 (12%) experienced an increased number of exacerbations; these were associated with secondary hypogammaglobulinemia (n=5), aspergillosis (n=3), and concurrent alpha-1-antitrypsin deficiency (n=1).
Among the 68 patients with RA-associated bronchiectasis who received rituximab, 11.8% discontinued treatment due to lung exacerbation (n=3) or lung infection-related death (n=5). Among the 46 TNFi-treated patients with RA-associated bronchiectasis, 32.6% discontinued treatment due to lung exacerbations (n=13) or lung infection–related death (n=2). Death rates due to respiratory causes were similar between the groups (7.4% for the rituximab-treated group vs 4.3% for the TNFi-treated group). After adjusting for age, sex, and center effect, a significantly better rate of 5-year respiratory survival was seen in rituximab-treated patients compared with TNFi-treated patients (hazard ratio, 0.40; 95% CI, 0.17-0.96; P =.041).
Study investigators concluded that “because most patients with [RA-associated bronchiectasis] had stable or improved lung exacerbations during [rituximab] therapy as well as better 5-year respiratory survival against a matched TNFi cohort, our findings offer reassurance that [rituximab] is an acceptable treatment choice for [patients with RA-associated bronchiectasis and] severe arthritis, who require treatment with a biologic. These data also support a definitive study of [rituximab] for the management of [RA-associated bronchiectasis] from both an articular and a respiratory perspective.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Md Yusof MY, Iqbal K, Darby M, et al. Effect of rituximab or tumour necrosis factor inhibitors on lung infection and survival in rheumatoid arthritis-associated bronchiectasis [published online February 17, 2020]. Rheumatology (Oxford). doi:10.1093/rheumatology/kez676