Table 2.

RA-ILD treatment

Treatment	Mechanism	Route and dosing	ILD outcomes (number of RA-ILD patients)	Treats joints	Side effects
Mycophenolate mofetil	Decreases synthesis of guanine nucleotides and reduces T and B lymphocyte proliferation and antibody formation	Oral: 1.0–1.5 g twice daily	Single-center cohort: FVC and DLCO stability (n = 18)60 Single-center cohort: FVC and DLCO stability (n = 43)61 Multi-center cohort: FVC and DLCO improvement (n = 77)16	No62	GI upset, cytopenia, recurrent infections, elevated liver enzymes
Azathioprine	Pro-drug of 6-mercaptopurine; inhibits purine synthesis	Oral 1.5–2 mg/kg IBW once daily, not to exceed 200 mg/day	Single-center cohort: FVC and DLCO improvement (n = 54)61 Multi-center cohort: FVC and DLCO improvement (n = 92)16	Yes63	GI upset, elevated liver enzymes, cytopenia, recurrent infections
Rituximab	Anti-CD20 antibody	IV 1 g once every 2 weeks for 2 doses, repeat every 24 weeks	Multi-center cohort: FVC and DLCO improvement (n = 43)16 RCT: progression-free survival benefit (n = 3)67	Yes94	GI upset, cytopenia, recurrent infections
Abatacept	T-lymphocyte costimulatory inhibitor	SQ: 125 mg once weekly or IV: 500 mg to 1 g every 4 weeks	Multi-center cohort: FVC and DLCO stability, HRCT stability (n = 263)73	Yes68,73	Recurrent or serious infections, cutaneous infusion reaction
Nintedanib	Tyrosine kinase inhibitor	Oral: 150 mg twice daily	RCT: slow FVC decline (n = 89)80,81	No	Diarrhea, nausea, vomiting, decreased appetite, elevated liver enzymes, weight loss
Pirfenidone	Suppresses TGF-β1, modulates fibrogenic growth factors, and downregulates inflammatory pathways100	Oral: 801 mg 3 times daily	RCT: slow FVC decline (n = 231)15	No	Nausea, headache, anorexia

Abbreviations; DLCO, diffusing capacity for carbon monoxide; FVC, forced vital capacity; ILD, interstitial lung disease; IV, intravenous; RA, rheumatoid arthritis; RCT, randomized controlled trial; SQ, subcutaneous; IBW, ideal body weight.