(A733) Risk of Cricoarytenoid Arthritis Among Rheumatoid Arthritis Patients Treated with Methotrexate vs Infliximab vs Adalimumab

Introduction: Methotrexate (MTX), a dihydrofolate reductase inhibitor, and infliximab (IFX), a TNF-α inhibitor, are among the most common treatments for rheumatoid arthritis (RA). Patients with contraindications to MTX, including liver disease or MTX-related toxicity, may be managed with alternative therapies such as IFX or adalimumab (ADA). We aim to compare the risk of developing Cricoarytenoid joint arthritis (CAJA), a rare complication associated with inadequately treated RA, among RA patients treated with MTX, IFX, or ADA.

Methods: We conducted a retrospective cohort study utilizing de-identified patient data from the TriNetX platform, a comprehensive electronic health records system consisting of 143 healthcare systems and more than 163 million patients' clinical records from 18 participating countries. Risk of CAJA among RA patients treated with MTX, IFX, or ADA was assessed. Propensity score matching was employed to balance baseline characteristics, including age, sex, ethnicity, and co-morbidities between cohorts.

Results: The risk of developing CAJA was not significantly different between patients treated with IFX or ADA (p-value 0.07, Risk Ratio 1.298, 95% CI (0.977,1.724)), while risk for the MTX cohort was 0.294% (N=22,128, patients with the outcome=65) when compared to IFX (N=22,120, total patients with the outcome=109) and 0.32% when compared to ADA (N=76,886, total patients with the outcome=246 (p-value 0.0008 and 0.1471, Risk Ratio 0.596 and 0.881, respectively).

Conclusions: MTX demonstrated superior efficacy in preventing CAJA in RA patients than the two TNF-α inhibitors. Among RA patients with MTX contraindications, such as liver disease, ADA may be considered an alternative to IFX due to their comparable risk prevention performance observed in this study. However, further research is needed to comprehensively evaluate the efficacy of these TNF-α inhibitors as MTX substitutes. Due to its presentation as a laryngeal mass, CAJA is often mistaken for squamous cell carcinoma of the larynx, further emphasizing the importance of early intervention to prevent upper airway obstruction.