A team of local researchers, led by Bryant England, MD, PhD, from UNMC and the Omaha VA, uncovered new data for treating patients with chronic lung disorders associated with rheumatoid arthritis.
Dr. England, an associate professor in the UNMC Division of Rheumatology, led a team of 15 authors who found medications once thought to cause poor outcomes in patients with rheumatoid arthritis interstitial lung disease actually have no adverse effects. The study was published in Lancet Rheumatology this month.
Researchers spent two years combing data collected from 2006 to 2018 on patients with rheumatoid arthritis interstitial lung disease who had been treated at VA Medical Centers.
To treat rheumatoid arthritis, doctors commonly prescribe tumor necrosis factor inhibitors, or TNF inhibitors, biologic medicine that helps reduce inflammation and alleviate joint symptoms. Prior studies suggested that those medications could cause poor outcomes in individuals with rheumatoid arthritis interstitial lung disease, Dr. England said.
“We were skeptical of those prior studies due to limitations in their study designs,” he said. “In clinical practice, we’ve seen a number of people on those medications who have done really well.”
The research team used real-world data to simulate a trial comparing the outcomes of patients treated with TNF inhibitors to those treated with other biologic medicines. They followed the patients over time, tracking deaths, respiratory hospitalizations and other variables, Dr. England said.
The study did not differentiate between patients receiving the drug for joint inflammation purposes or for treating lung disease. However, researchers found no significant differences in survival rates or respiratory hospitalization rates.
The data, Dr. England said, doesn’t suggest that TNF inhibitors are harmful to patients with rheumatoid arthritis interstitial lung disease. But the data did not show whether TNF inhibitors are effective at treating lung disease, he said.
Because the condition is rare, Dr. England said, conducting clinical trials are challenging. But researchers are in the process of trying to design trials to answer remaining questions.
Prior concerns meant physicians wouldn’t offer TNF inhibitors to patients with rheumatoid arthritis interstitial lung disease. Those patients missed out on medication that would be highly effective for their joints. The new study shows that the drugs are safe to offer to patients.
“It’s a very specific but important conclusion from this study — that we should not universally avoid TNF inhibitors in rheumatoid arthritis interstitial lung disease, but we don’t know if they’re beneficial for the lungs,” Dr. England said.