Document Type
Capstone Experience
Graduation Date
5-2024
Degree Name
Master of Public Health
Department
Biostatistics
First Committee Member
Christopher S. Wichman
Second Committee Member
Jianghu Dong
Third Committee Member
Bryant R. England
Abstract
Background/Objectives: There is a paucity of evidence on the safety and effectiveness of non- TNFi biologic therapies in RA-ILD, this study aimed to compare treatment outcomes in RA-ILD between rituximab, abatacept, IL-6i, and JAKi using the Target Trial Emulation Framework.
Methods: We emulated 3 trials comparing abatacept, IL-6i, and JAKi with rituximab (reference). Patients fulfilling validated RA-ILD algorithms initiating one of these non-TNFi b/tsDMARDs were propensity score (PS)-matched (1:1) using national Veterans Affairs (VA) data from 2006 to 2020. PS models included demographics, comorbidities, general health status indicators, and RA- and ILD-related severity measures. Study outcomes were death and respiratory-related hospitalization, ascertained by VA data and linkages to the National Death Index and Medicare, over 3-year and 1-year follow-up periods. Cox regression models with univariate frailty correction were used to analyze study outcomes. Sensitivity analyses were performed among cohorts with modified eligibility criteria.
Results: In the primary cohort, we 1:1 matched abatacept (n=159), IL-6i (n=78), and JAKi (n=94) with rituximab initiators [age (mean range 68.1-69.9 years), male (range 87-91%), white (range 78-84%)]. There was not a significant difference in the primary composite outcome among any of the comparisons [abatacept = HR: 0.90 [0.64, 1.26]; IL-6i = HR: 0.97 [0.62, 1.53], aHR: 0.93 [0.59, 1.47]; JAKi= HR: 0.85 [0.53,1.36], aHR: 0.69 [0.41, 1.14]]. Sensitivity analyses supported the findings.
Conclusions: We did not find significant differences in outcomes between non-TNFi b/tsDMARDs, though estimates were imprecise. These findings emphasize the need for clinical trials of advanced immunomodulatory therapies in RA-ILD.
Recommended Citation
Frideres, Halie E., "Non-TNFi Biologic and Targeted Synthetic DMARDs in Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Comparative, Propensity Score-Matched Study Using National Veterans Affairs Data" (2024). Capstone Experience. 318.
https://digitalcommons.unmc.edu/coph_slce/318