Advanced therapies in US veterans with rheumatoid arthritis-associated interstitial lung disease: a retrospective, active-comparator, new-user, cohort study
Abstract
Background: There is uncertainty regarding patient outcomes with using tumor necrosis factor inhibitors (TNFi) vs. other biologic and targeted-synthetic disease-modifying anti-rheumatic drugs (non-TNFi b/tsDMARDs) in rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Therefore, we compared survival and respiratory hospitalization outcomes following TNFi or non-TNFi b/tsDMARD treatment initiation in RA-ILD. Methods: We performed an active-comparator, new-user cohort study with propensity score matching following the Target-Trial-Emulation Framework using national U.S. Veterans Affairs (VA) electronic and administrative health records between 1/1/2006 and 6/30/2021. VA healthcare enrollees fulfilling a validated administrative algorithm for RA-ILD and no prior receipt of ILD directed therapies (e.g., antifibrotics) initiating a TNFi or non-TNFi b/tsDMARD were studied. Propensity score matching was performed using demographics, healthcare utilization, health behaviors, comorbidity burden, RA-related severity factors, and ILD-related severity factors, including baseline forced vital capacity. Study outcomes were respiratory hospitalization, all-cause mortality, and respiratory-related death over up to 3-years of follow-up from VA, Medicare, and National Death Index data. Patients were not involved in the study. Findings: We matched 237 TNFi and 237 non-TNFi initiators with a mean age of 68 years and 92% (n=234) being male. The composite outcome of death or…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 234 participants or records.
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