Post-progression treatment patterns in systemic autoimmune rheumatic disease-associated interstitial lung disease: insights from a US retrospective, observational study

OBJECTIVE: Patients with systemic autoimmune rheumatic disease (SARD) are at high risk of developing interstitial lung disease (ILD). We sought to gain insight into the pharmacological and non-pharmacological treatments being used by patients with SARD-associated ILD (SARD-ILD) following ILD progression. DESIGN: This was a retrospective, observational cohort study. SETTING: Optum Clinformatics Data Mart administrative medical and pharmacy claims database in the USA. PARTICIPANTS: Patients with SARD-ILD who had an incident ILD diagnosis and progression between January 2018 and March 2023. PRIMARY AND SECONDARY OUTCOME MEASURES: Treatment patterns and healthcare services utiliation were descriptively summarised for baseline and follow-up periods. RESULTS: We identified 6431 patients with SARD-ILD and evidence of ILD progression (mean age, 71.2 years; 75.3% female; 68.9% white). The mean (SD) time between the initial SARD-ILD diagnosis and the onset of ILD progression (index date) was 104 (201) days. On average, patients were followed for 936 (467) days.Oral corticosteroids were the most common treatment post-progression (69.5%), followed by non-biologic disease-modifying antirheumatic drugs (non-biologic DMARDs) (41.6%), biologic DMARDs (15.5%) and immunomodulators (15.4%). Antifibrotics were received by 3.5% of patients. Supplemental oxygen was the most frequent non-pharmacological treatment (48.9%). For the baseline period, 53.0% and 42.1% of patients used inpatient and emergency department services, respectively. During the follow-up, 69.7% and 62.8%, respectively, used these services. CONCLUSION: The high use of corticosteroids and limited use of DMARDs and antifibrotics post-progression in this descriptive study implies a significant gap between current practice and optimal management of patients with SARD-ILD.