Rheumatoid Arthritis Clinical Trial
Official title:
Safety of Abatacept in Rheumatoid Arthritis Associated Interstitial Lung Disease: A Feasibility Trial
Early initiation of treatment for Rheumatoid arthritis (RA) can prevent several of the long
term problems associated with the condition. However, many RA patients develop lung
inflammation and scarring, called 'interstitial lung disease' (RA-ILD), contributing to early
death in 1 in 5 people. There is no proven treatment for these patients and some medications
for RA can in fact worsen their lung disease. There is a need therefore to find safe
medications that can not only control RA joint disease, but also prevent progression of
RA-ILD. Abatacept is an approved drug for treating RA and is used widely. It is a newer RA
medication, with a unique mechanism of action, and it has been shown to prevent progression
of joint damage and improve physical function. The investigators aim to assess the safety of
this medication in patients with RA-ILD and improve our understanding of the mechanism of
lung damage in rheumatoid disease.
The investigators will perform a small clinical trial to assess the feasibility of performing
a larger randomized controlled trial. A total of 30 patients with RA-ILD will be treated with
abatacept infusions fortnightly for the first month, then every 4 weeks for a total of 20
weeks. In order to be eligible for the study, a patient must be able to provide written
informed consent, be aged ≥18 years, and have interstitial lung disease that has not
responded to or progressed over 6 months despite conventional immunosuppression. Change in
lung function (forced vital capacity) at 24 weeks will be evaluated. To assess the mechanisms
that may be involved with the development of ILD, the investigators will assess the effects
of abatacept on biomarkers obtained from the blood and the lung (bronchoalveolar lavage),
including markers of infection (the lung microbiome).
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