Antifibrotic Agents in Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Systematic Review and...

Area of Science:

• Pulmonology
• Rheumatology
• Pharmacology

Background:

• Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a serious complication of rheumatoid arthritis (RA).
• Currently, no definitive treatment exists for RA-ILD, impacting patient morbidity and mortality.
• Antifibrotic agents are being investigated for their potential therapeutic effects.

Purpose of the Study:

• To conduct a meta-analysis evaluating the efficacy of antifibrotic agents in patients with RA-ILD.
• To confirm the clinical effects of nintedanib and pirfenidone on disease progression in RA-ILD.

Main Methods:

• A systematic literature search was performed across multiple databases (Ovid MEDLIVE, Cochrane Library, EMBASE, KoreaMed).
• Two randomized controlled studies comparing nintedanib or pirfenidone to placebo in adult RA-ILD patients were included.
• The primary outcomes assessed were changes in forced vital capacity (FVC) and the proportion of patients with a ≥10% increase in predicted FVC over 52 weeks.

Main Results:

• The meta-analysis of two studies revealed that antifibrotic agents significantly reduced FVC decline compared to placebo (mean difference: 88.30).
• Fewer patients in the antifibrotic agent group experienced a ≥10% increase in predicted FVC compared to placebo (Odds ratio: 0.42, p=0.04).
• No significant heterogeneity was observed between the included studies (I² = 0%).

Conclusions:

• Nintedanib and pirfenidone demonstrate clinical utility in mitigating disease progression in RA-ILD patients.
• These findings suggest antifibrotic agents may be a viable treatment option for RA-ILD.
• Further research is warranted to solidify the clinical benefits of antifibrotic agents in RA-ILD.