Real-world association of biologic and targeted synthetic DMARD use with mortality in rheumatoid arthritis-associated interstitial lung disease: a nationwide cohort study
5 affiliations
- 1Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
- 2Hanyang University Institute for Rheumatology Research, Seoul, Korea
- 3Department of Medicine, College of Medicine, Hanyang University, Seoul, Korea
- 4Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, Seoul, Korea
- 5Hanyang Institute of Bioscience and Biotechnology, Seoul, Korea
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.
Related
- Contemporary Guideline Perspectives on Methotrexate and Biologic/Targeted Synthetic Disease-Modifying Antirheumatic Drugs (DMARDs) in Rheumatoid Arthritis-Associated Interstitial Lung Disease
- Lung Ultrasound in Rheumatoid Arthritis–Associated Interstitial Lung Disease: Association with Radiological Patterns, Lung Function Tests, and Disease Activity—A Single-Center Retrospective Cross-Sectional Study
- Granulomatous Interstitial Nephritis Associated With Adalimumab Therapy in a Patient With Rheumatoid Arthritis: A Case Report
- Screening for rheumatoid arthritis-associated interstitial lung disease using lung ultrasound: a systematic review and quality appraisal of recent studies
- Baseline Disease Activity and Moderate-to-High Disease Activity at 6 Months in Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Multicentre Real-World Study from the ANSWER Cohort
BibTeX
@article{joo2026realworld,
title = {{Real-world association of biologic and targeted synthetic DMARD use with mortality in rheumatoid arthritis-associated interstitial lung disease: a nationwide cohort study}},
author = {Young Bin Joo and Soorack Ryu and Junwon Go and So-Young Bang and Sang-Cheol Bae and Hye-Soon Lee},
journal = {RMD Open},
year = {2026},
month = oct,
doi = {10.1136/rmdopen-2026-007179},
url = {https://doi.org/10.1136/rmdopen-2026-007179},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Real-world association of biologic and targeted synthetic DMARD use with mortality in rheumatoid arthritis-associated interstitial lung disease: a nationwide cohort study
AU - Young Bin Joo
AU - Soorack Ryu
AU - Junwon Go
AU - So-Young Bang
AU - Sang-Cheol Bae
AU - Hye-Soon Lee
PY - 2026
DA - 2026/10/23
JO - RMD Open
DO - 10.1136/rmdopen-2026-007179
UR - https://doi.org/10.1136/rmdopen-2026-007179
AB - 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.
SN - 2056-5933
ER -