FRI0067 Lack of Response is Associated with Acute Exacerbation of Interstitial Lung Disease During Tocilizumab Treatment in Patients with Rheumatoid Arthritis

Background Rheumatoid arthritis associated interstitial lung disease (RA-ILD) is a common extra-articular manifestation and acute exacerbation (AE) is sometimes critical. While the prognosis of RA has been improved with biologic agents including tocilizumab (TCZ), risk factors associated with AE during biologic treatment remain unclear. Objectives To investigate risk factors associated with AE in patients with RA-ILD during TCZ treatment. Methods Three hundred ninety five RA patients treated with TCZ in our institution from June 2008 to December 2014 were retrospectively reviewed. Patients were grouped based on existence (RA-ILD) or absence (non-ILD) of ILD according to high-resolution computed tomography (HRCT). AE of RA-ILD was defined based on the IPF Clinical Research Network criteria 1 with a modification for adaptation to RA-ILD: previous diagnosis of RA-ILD, HRCT with new bilateral ground-glass opacities with or without areas of consolidation superimposed on RA-ILD, and the absence of infection or another identifiable etiology. RA-ILD group was further subgrouped into with or without AE (AE and non-AE group, respectively). Characteristics at baseline and post-treatment were compared. Results Three hundred seventeen patients were classified into non-ILD and 78 patients (19.7%) were classified into RA-ILD group. Multivariate analysis revealed that risk factors for RA-ILD were age over 60 (OR 11.3; 95% CI 3.9-32.6; p Conclusions Remaining in high or moderate disease activity at 12 weeks after TCZ initiation associated with AE of RA-ILD. This suggests post-treatment monitoring of disease activity is important not only in aspect of RA itself but also RA-ILD. References Collard HR, Moore BB, Flaherty KR, et al. Acute exacerbations of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2007;176:636-43. Disclosure of Interest M. Akiyama: None declared, Y. Kaneko Consultant for: Abbvie, Paid instructor for: Eisai Pharmaceutical, Chugai Pharmaceutical, Astellas Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Pfizer, Speakers bureau: Abbvie, Eisai Pharmaceutical, Chugai Pharmaceutical, Bristol Myers Squibb, Astellas Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Pfizer, Janssen, UCB, H. Kondo: None declared, K. Yamaoka Speakers bureau: Pfizer, Chugai Pharma, Mitsubishi-Tanabe Pharma, Takeda Industrial Pharma, GlaxoSmithKline, Nippon Shinyaku, Eli Lilly, Janssen Pharma, Eisai Pharma, Astellas Pharma and Actelion Pharmaceuticals, T. Takeuchi Grant/research support from: Astellas Pharma, Bristol–Myers K.K., Chugai Pharmaceutical Co, Ltd., Daiichi Sankyo Co., Ltd., Eisai Co., Ltd., Mitsubishi Tanabe Pharma Co., Pfizer Japan Inc., Santen Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Teijin Pharma Ltd., AbbVie GK, Asahikasei Pharma Corp., and Taisho Toyama Pharmaceutical Co., Ltd.,SymBio Pharmaceuticals Ltd., Consultant for: Astra Zeneca K.K., Eli Lilly Japan K.K., Novartis Pharma K.K., Mitsubishi Tanabe Pharma Co., and Asahi Kasei Medical K.K.,abbivie GK, Daiichi Sankyo Co.,Ltd., Bristol–Myers K.K., Nipponkayaku Co.Ltd., Paid instructor for: Mitsubishi Tanabe Pharma Co., Eisai Co., Ltd., Abbivie GK., Speakers bureau: AbbVie GK., Bristol–Myers K.K., Chugai Pharmaceutical Co,. Ltd., Eisai Co., Ltd., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., Pfizer Japan Inc., and Takeda Pharmaceutical Co., Ltd., Astellas Pharma, and Diaichi Sankyo Co.,Ltd., Celtrion, Nipponkayaku Co.Ltd