Stable ILD as a predictor of survival in CTD

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Background: The impact of various definitions of disease progression on survival in connective tissue disease-associated interstitial lung disease (CTD-ILD) has been well studied. However, the prognostic value of stable ILD remains underexplored. Objective: To evaluate the frequency of stable ILD and its impact on transplant-free survival (TFS) in CTD-ILD patients. Method: We conducted a prospective study of CTD-ILD at Oslo University Hospital with baseline and 12-month assessments. Stability was defined using one or more of the following criteria: stable respiratory symptoms, absolute FVC decline <5%, absolute DLCO decline <10%, and stable ILD on HRCT. Symptomatic stability was determined through detailed patient history. TFS was analyzed using Kaplan-Meier estimates and Cox regression with the landmark method. Results: Of 103 patients, 37 (36%) met all stability criteria, and 74 (72%) had stable respiratory symptoms. TFS was significantly better in patients with stable respiratory symptoms (HR 0.20, 95% CI 0.05–0.84, p=0.03). In contrast, stable FVC (HR 0.28, 95% CI 0.06–1.28, p=0.1), stable DLCO (HR 0.43, 95% CI 0.05–3.57, p=0.4), stable HRCT (HR 0.65, 95% CI 0.16–2.60, p=0.5), and combined stability criteria (HR 0.28, 95% CI 0.03–2.35, p=0.2) were not significantly associated with TFS. Conclusion: In this CTD-ILD cohort, stable respiratory symptoms emerged as a strong predictor of transplant-free survival, outperforming stability in FVC, DLCO, and HRCT findings. erj;66/suppl_69/PA6104/F1 F1 F1

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