Tocilizumab therapy in rheumatoid arthritis with interstitial lung disease: a multicentre retrospective study

Abstract Background Interstitial lung disease (ILD) is the most severe extra‐articular manifestation of rheumatoid arthritis (RA). Although it is responsible of 10–20% of all RA mortality, no controlled studies are available for the treatment of RA‐ILD and its therapeutic approach is still debated. Aims To analyse the evolution of ILD in a population of RA patients treated with tocilizumab (TCZ). Methods In this national multicentre study, we retrospectively collected patients with RA‐ILD treated with at least one dose of TCZ. For each patient, disease activity and serological data were evaluated. Moreover, we analysed the evolution of high‐resolution computed tomography (HRCT) and pulmonary function tests, including forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO). Results Twenty‐eight RA‐ILD patients were identified (females/males 18/10, mean age 61.6 years), with a mean follow up for TCZ therapy of 30 months. At the end of follow up, FVC remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%). DLCO remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%), even though in 3 patients DLCO and FVC showed an opposite trend. HRCT remained stable in the majority (25) of cases, worsened in two patients with a usual interstitial pneumonia pattern and improved in only one case with a non‐specific interstitial pneumonia pattern. Conclusions The management of RA‐ILD patients remains a critical unmet need. TCZ demonstrated a good safety profile in patients with RA‐ILD and a potential effect on the stabilisation of lung involvement.