TNF Inhibitors vs Non-TNF DMARDs in Rheumatoid Arthritis-Associated Lung Disease

Mar 24, 2025

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The following is a summary of “Advanced therapies in US veterans with rheumatoid arthritis-associated interstitial lung disease: a retrospective, active-comparator, new-user, cohort study,” published in the March 2025 issue of Lancet Rheumatology by England et al.

Patient outcomes with TNF inhibitors vs. other disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis-associated interstitial lung disease (ILD) remain uncertain.

Researchers conducted a retrospective study comparing survival and respiratory hospitalization outcomes in rheumatoid arthritis-associated ILD after TNF or non-TNF DMARD initiation.

They conducted a retrospective cohort study using VA records (2006–2018) following the target trial emulation framework. VA enrollees with rheumatoid arthritis-associated ILD, no prior ILD-directed therapy, and newly initiating TNF or non-TNF inhibitors were included. Propensity score matching used demographics, health behaviors, comorbidities, rheumatoid arthritis and ILD severity, including baseline forced vital capacity. Outcomes included respiratory hospitalization, all-cause mortality, and respiratory-related death over up to 3 years using VA, Medicare, and National Death Index data.

The results showed that of 1,047 patients, 237 TNF and 237 non-TNF inhibitor users were matched (mean age 68 years [SD 9]); 434 (92%) were male, and 40 (8%) were female. Death and respiratory hospitalization did not differ (HR 1.21 [95% CI 0.92–1.58]). Respiratory hospitalization (1.27 [0.91–1.76]), all-cause mortality (1.15 [0.83–1.60]), and respiratory mortality (1.38 [0.79–2.42]) were similar. Secondary, sensitivity, and subgroup analyses supported these findings.

Investigators found no difference in outcomes between TNF and non-TNF inhibitors in rheumatoid arthritis-associated ILD. These findings did not support systematically avoiding TNF inhibitors, but efficacy trials were needed due to potential bias.

Source: thelancet.com/journals/lanrhe/article/PIIS2665-9913(24)00265-0/abstract