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Doyle TJ, Dhillon N, Madan R, Cabral F, Fletcher EA, Koontz DC, Aggarwal R, Osorio JC, Rosas IO, Oddis CV, Dellaripa PF. Rituximab in the Treatment of Interstitial Lung Disease Associated with Antisynthetase Syndrome: A Multicenter Retrospective Case Review. J Rheumatol 2018; 45:841-850. [PMID: 29606668 DOI: 10.3899/jrheum.170541] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess clinical outcomes including imaging findings on computed tomography (CT), pulmonary function testing (PFT), and glucocorticoid (GC) use in patients with the antisynthetase syndrome (AS) and interstitial lung disease (ILD) treated with rituximab (RTX). METHODS We retrospectively identified all patients at 2 institutions with AS-ILD who were treated with RTX. Baseline demographics, PFT, and chest CT were assessed before and after RTX. Two radiologists independently evaluated CT using a standardized scoring system. RESULTS Twenty-five subjects at the Brigham and Women's Hospital (n = 13) and University of Pittsburgh Medical Center (n = 12) were included. Antisynthetase antibodies were identified in all patients (16 Jo1, 6 PL-12, 3 PL-7). In 21 cases (84%), the principal indication for RTX use was recurrent or progressive ILD, owing to failure of other agents. Comparing pre- and post-RTX pulmonary variables at 12 months, CT score and forced vital capacity were stable or improved in 88% and 79% of subjects, respectively. Total lung capacity (%) increased from 56 ± 13 to 64 ± 13 and GC dose decreased from 18 ± 9 to 12 ± 12 mg/day. Although DLCO (%) declined slightly at 1 year, it increased from 42 ± 17 to 70 ± 20 at 3 years. The most common imaging patterns on CT were nonspecific interstitial pneumonia (NSIP; n = 13) and usual interstitial pneumonia/fibrotic NSIP (n = 5), of which 5 had concurrent elements of cryptogenic organizing pneumonia. CONCLUSION Stability or improvement in pulmonary function or severity of ILD on CT was seen in most patients. Use of RTX was well tolerated in the majority of patients. RTX may play a therapeutic role in patients with AS-ILD, and further clinical investigation is warranted.
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Affiliation(s)
- Tracy J Doyle
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Namrata Dhillon
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Rachna Madan
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Fernanda Cabral
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Elaine A Fletcher
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Diane C Koontz
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Rohit Aggarwal
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Juan C Osorio
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Ivan O Rosas
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Chester V Oddis
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital
| | - Paul F Dellaripa
- From the Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Departments of Medicine and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. .,T.J. Doyle, MD, MPH, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; N. Dhillon, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Madan, MD, Department of Radiology, Brigham and Women's Hospital; F. Cabral, MD, Department of Radiology, Brigham and Women's Hospital; E.A. Fletcher, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; D.C. Koontz, BS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; R. Aggarwal, MD, MS, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; J.C. Osorio, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; I.O. Rosas, MD, Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School; C.V. Oddis, MD, Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine; P.F. Dellaripa, MD, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital.
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