Work

Real-world association of biologic and targeted synthetic DMARD use with mortality in rheumatoid arthritis-associated interstitial lung disease: a nationwide cohort study

Year: 2026

Type: article

Abstract: Objectives To investigate the association between biologic and targeted synthetic disease-modifying antirheumatic drug (b/tsDMARD) use and all-cause mortality and cause-specific mortality in patients with rheumatoid arthritis-associated interstitial lung disease (RA-ILD).Methods We identified patients with incident RA-ILD between 2010 and 2021 using the National Health Insurance database. The index date was the date of RA-ILD diagnosis, and subsequent b/tsDMARD use was treated as time-dependent exposure. Inverse probability of treatment weighting (IPTW) was used to balance measured baseline covariates. All-cause mortality was analysed using time-dependent Cox proportional hazards models and cause-specific mortality using time-dependent Fine–Grey competing-risk models.Results Among 6292 patients with RA-ILD, 1074 received b/tsDMARD during follow-up and 5218 received conventional synthetic DMARDs only. 1964 deaths occurred. After IPTW, b/tsDMARD use was associated with lower all-cause mortality (HR 0.75, 95% CI 0.62 to 0.89), respiratory-related mortality (subdistribution HR (sHR) 0.72, 95% CI 0.56 to 0.91) and ILD-related mortality nested within respiratory mortality (sHR 0.63, 95% CI 0.43 to 0.88). No statistically significant associations were observed for cardiovascular, cancer-related or infection-related mortality. In class-specific analyses, HRs for all-cause mortality versus non-b/tsDMARDs were 0.61 (95% CI 0.44 to 0.86) for tumour necrosis factor inhibitors, 0.71 (0.53 to 0.9) for abatacept, 0.68 (0.52 to 0.89) for tocilizumab, 0.76 (0.28 to 2.06) for rituximab and 0.61 (0.39 to 0.95) for Janus kinase inhibitors.Conclusions b/tsDMARD use was associated with lower all-cause mortality and respiratory-related mortality in patients with RA-ILD. Further studies incorporating clinical, pulmonary function and radiological data are needed to confirm these findings.

Source: RMD Open

DOI: 10.1136/rmdopen-2026-007179

Authors: Young Bin Joo, Soorack Ryu, Junwon Go, So-Young Bang, Sang-Cheol Bae, Hye-Soon Lee

Institutions: Hanyang University Seoul Hospital, Hanyang University Hospital for Rheumatic Disease, Hanyang University

Language: English

Topic: Rheumatoid Arthritis Research and Therapies

Subfield: Rheumatology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,391