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TOPLINE:

Among patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD), abatacept was linked to better outcomes, including a lower risk for mortality, hospitalization, or mechanical ventilation, than rituximab.

METHODOLOGY:

• Researchers conducted a retrospective cohort study comparing the effectiveness and safety of abatacept vs rituximab for RA-ILD using an emulated target trial design, with data obtained from the TriNetX US Collaborative Network database.
• Adults diagnosed with RA-ILD who initiated abatacept treatment were propensity matched with those who initiated rituximab (n = 1615 in each treatment group) between January 2007 and June 2024.
• The primary outcome was all-cause mortality, and secondary outcomes included hospitalization, mechanical ventilation, medical utilization, and infection-related complications such as bacteremia and pneumonia.

TAKEAWAY:

• Treatment with abatacept was associated with lower risk for all-cause mortality than treatment with rituximab (hazard ratio [HR], 0.689; 95% CI, 0.581-0.818) during the 5-year follow-up period.
• Additionally, abatacept treatment was associated with reduced risks for hospitalization (HR, 0.882; 95% CI, 0.776-0.977) and mechanical ventilation (HR, 0.698; 95% CI, 0.521-0.934).
• Patients receiving abatacept had a lower incidence of pneumonia than those receiving rituximab (HR, 0.858; 95% CI, 0.754-0.977); however, the risk for bacteremia remained comparable between the groups.
• Abatacept users demonstrated significantly reduced risks for cyclophosphamide use (HR, 0.162; 95% CI, 0.090-0.291) and immunoglobulin use (HR, 0.232; 95% CI, 0.157-0.343).

IN PRACTICE:

“This large, real-world target-trial emulation strengthens the evidence that abatacept may offer a more favorable outcome than rituximab in RA-ILD, with consistently lower risks of all-cause mortality across the subgroup and sensitivity analyses. By providing the first head-to-head comparison of these two biologics, the study provides a critical evidence gap in RA-ILD management,” the authors wrote.

SOURCE:

The study was led by Po-Cheng Shih, MD, Chung Shan Medical University, Taichung, Taiwan. It was published online on July 22, 2025, in Arthritis & Rheumatology.

LIMITATIONS:

Despite extensive matching, residual confounding by indication and unmeasured factors (eg, detailed smoking history, RA activity scores, and imaging-based ILD severity) may have existed. ILD diagnoses relied on diagnostic codes without direct radiologic or full pulmonary function confirmation, which may have led to misclassification. As this was a retrospective observational US-based study, causality could not be definitively established, and the findings may not be generalizable to other settings internationally.

DISCLOSURES:

No funding was received for this study. The authors reported having no relevant conflicts of interest. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.