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Lai YK, Sharifi H, Hsu JL. How I diagnose and treat organizing pneumonia in hematopoietic cell transplant recipients. Blood 2024; 144:1048-1060. [PMID: 38864640 DOI: 10.1182/blood.2023023249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/07/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024] Open
Abstract
ABSTRACT Organizing pneumonia (OP) is a known noninfectious pulmonary complication following allogeneic hematopoietic cell transplant (HCT) and represents a significant risk factor for nonrelapse mortality in HCT recipients. Unlike bronchiolitis obliterans syndrome, it is not universally acknowledged as a distinctive pulmonary manifestation of chronic graft-versus-host disease (cGVHD) and, therefore, its diagnostic criteria and management approach are lacking. Given its shared similar clinical features and radiological and histologic findings to OP in the non-HCT population, the diagnostic approach and treatment strategy for OP in HCT recipients is largely adapted from the non-HCT population. In this article, we aim to enhance the understanding of OP within the context of cGVHD following HCT and distinguish its clinical features and treatment strategy from non-HCT counterparts, thereby reinforcing its recognition as a pulmonary manifestation of graft-versus-host disease. We will propose the diagnostic criteria and outline our approach in diagnosis and treatment strategy, highlighting the potential challenges that may arise in each process. Finally, we will discuss knowledge gaps in this field and identify the area of need for future research.
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Affiliation(s)
- Yu Kuang Lai
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Husham Sharifi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Joe L Hsu
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
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Kodera T, Tsutsumi T, Oka Y, Takeda T, Shirota Y, Kameoka J. Two cases of rheumatoid arthritis complicated by organising pneumonia successfully treated with tofacitinib therapy. Mod Rheumatol Case Rep 2021; 5:218-225. [PMID: 33784938 DOI: 10.1080/24725625.2021.1899372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Organising pneumonia (OP) complicated by rheumatoid arthritis (RA), a rare type of interstitial lung disease, is sometimes refractory and resistant to immunosuppressive therapy. We report for the first time two cases of refractory OP with RA for which tofacitinib, an inhibitor of Janus kinase, was highly effective. Two women, aged 84 and 65 years, developed refractory OP during treatment for RA with biologics, certolizumab pegol, and etanercept. A moderate amount of prednisolone was effective in both cases; however, recurrences were observed with reduced glucocorticoid dosage. When tofacitinib was administered, OP and RA were well controlled. Thus, the glucocorticoid dosage was successfully tapered low enough until no side effects were observed. Tofacitinib therapy may be a treatment option for refractory OP.
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Affiliation(s)
- Takao Kodera
- Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tomomi Tsutsumi
- Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yumiko Oka
- Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tomoki Takeda
- Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yuko Shirota
- Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Junichi Kameoka
- Division of Hematology and Rheumatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Chen J, Chi S, Li F, Yang J, Cho WC, Liu X. Biologics-induced interstitial lung diseases in rheumatic patients: facts and controversies. Expert Opin Biol Ther 2017; 17:265-283. [PMID: 28117616 DOI: 10.1080/14712598.2017.1287169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Interstitial lung disease (ILD) is a common, devastating pulmonary complication. An increased number of reports suggesting that biological disease modifying antirheumatic drugs (DMARDs) induced or exacerbated ILDs in rheumatoid arthritis (RA) patients has garnered increased attention. Areas covered: This article discusses ILDs induced by or exacerbated during biological therapy in RA patients. The article summarizes the efficacy and safety of a variety of licensed and off-label biologics clinically used for rheumatic diseases, focusing on the onset or exacerbation of RA-associated ILDs (RA-ILDs) in RA patients treated with biologics targeting tumor necrosis factor, CD20, interleukin 1 (IL-1) and IL-6 receptors. Additionally, the pathogenesis of RA-ILDs is discussed. Expert opinion: To some extent, the possibility of biologic-induced RA-ILDs increases the difficulty in choosing an optimal regimen for RA treatment with biological agents, as the relationship between biological therapy safety and the induction or exacerbation of RA-ILDs has not been established. A framework to assess baseline disease severity, particularly standardizing the evaluation of the pulmonary condition stage in RA patients and monitoring the outcome during the biological therapy treatment, is highly needed and may substantially help guide treatment decisions and predict the treatment benefits.
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Affiliation(s)
- Juan Chen
- a Department of Pulmonary and Critical Care Medicine , General Hospital of Ningxia Medical University , Yinchuan , China
| | - Shuhong Chi
- b Department of Rheumatology , General Hospital of Ningxia Medical University , Yinchuan , China
| | - Feng Li
- c Center of Laboratory Medicine , General Hospital of Ningxia Medical University , Yinchuan , Ningxia , China
| | - Jiali Yang
- c Center of Laboratory Medicine , General Hospital of Ningxia Medical University , Yinchuan , Ningxia , China.,d Human Stem Cell Institute , General Hospital of Ningxia Medical University , Yinchuan , Ningxia , China
| | - William C Cho
- e Department of Clinical Oncology , Queen Elizabeth Hospital , Kowloon , Hong Kong
| | - Xiaoming Liu
- c Center of Laboratory Medicine , General Hospital of Ningxia Medical University , Yinchuan , Ningxia , China.,d Human Stem Cell Institute , General Hospital of Ningxia Medical University , Yinchuan , Ningxia , China
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Okada H, Kurasawa K, Yamazaki R, Tanaka A, Arai S, Owada T, Maezawa R, Ishii Y. Clinical features of organizing pneumonia associated with rheumatoid arthritis. Mod Rheumatol 2016; 26:863-868. [DOI: 10.3109/14397595.2016.1153217] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Harutsugu Okada
- Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi, Japan and
| | - Kazuhiro Kurasawa
- Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi, Japan and
- Center for Rheumatic Diseases, Dokkyo Medical University, Tochigi, Japan
| | - Ryutaro Yamazaki
- Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi, Japan and
| | - Ayae Tanaka
- Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi, Japan and
| | - Satoko Arai
- Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi, Japan and
| | - Takayoshi Owada
- Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi, Japan and
| | - Reika Maezawa
- Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi, Japan and
- Center for Rheumatic Diseases, Dokkyo Medical University, Tochigi, Japan
| | - Yoshiki Ishii
- Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi, Japan and
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Kawasumi H, Gono T, Tanaka E, Kaneko H, Kawaguchi Y, Yamanaka H. Clinical Characteristics and Cytokine Profiles of Organizing Pneumonia in Patients with Rheumatoid Arthritis Treated with or without Biologics. J Rheumatol 2016; 43:738-44. [PMID: 26834212 DOI: 10.3899/jrheum.151019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE It has been reported that organizing pneumonia (OP) develops when patients with rheumatoid arthritis (RA) are treated with biologic disease-modifying antirheumatic drugs (bDMARD). However, the clinical characteristics and pathophysiology of OP in RA remain unknown in patients treated with bDMARD. We investigated the clinical characteristics and cytokine profiles of patients with RA-OP treated with bDMARD or conventional synthetic DMARD (csDMARD). METHODS Twenty-four patients with RA who had developed OP were enrolled. These patients included 12 treated with bDMARD (bDMARD-OP subset) and 12 treated with csDMARD (csDMARD-OP subset). We compared the clinical characteristics and cytokine profiles between the patients with OP (OP subset, n = 24) and non-OP patients (non-OP subset, n = 29). RESULTS There was no significant difference in clinical characteristics between the OP subset and the non-OP subset. Four patients developed OP within 2 months of bDMARD administration. In the other 8 patients, OP developed more than 1 year after the initiation of bDMARD. OP improved with corticosteroid treatment in all bDMARD-OP patients. After OP improved, bDMARD were readministered in 6 patients, and no OP recurrence was observed in any of these patients. Our multivariate analysis revealed that serum levels of interferon-α (IFN-α), interleukin (IL)-1β, IL-6, IL-8, and interferon-γ-inducible protein 10 were significantly associated with the development of OP, although these cytokines tended to be lower in the bDMARD-OP subset than in the csDMARD-OP subset. CONCLUSION OP is unlikely to be fatal in patients treated with bDMARD or csDMARD. IFN-α and proinflammatory cytokines are associated with the pathophysiology of OP in RA.
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Affiliation(s)
- Hidenaga Kawasumi
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
| | - Takahisa Gono
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University.
| | - Eiichi Tanaka
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
| | - Hirotaka Kaneko
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
| | - Yasushi Kawaguchi
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
| | - Hisashi Yamanaka
- From the Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan.H. Kawasumi, MD, Assistant Professor, Institute of Rheumatology, Tokyo Women's Medical University; T. Gono, MD, PhD, Lecturer, Institute of Rheumatology, Tokyo Women's Medical University; E. Tanaka, MD, PhD, Associate Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Kaneko, MSc, Technical Researcher, Institute of Rheumatology, Tokyo Women's Medical University; Y. Kawaguchi, MD, PhD, Professor, Institute of Rheumatology, Tokyo Women's Medical University; H. Yamanaka, MD, PhD, Director, Professor, Institute of Rheumatology, Tokyo Women's Medical University
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Mori S, Koga Y, Sugimoto M. Organizing Pneumonia in Rheumatoid Arthritis Patients: A Case-Based Review. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2015; 9:69-80. [PMID: 26543387 PMCID: PMC4624096 DOI: 10.4137/ccrpm.s23327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/08/2015] [Accepted: 09/14/2015] [Indexed: 12/29/2022]
Abstract
We treated 21 patients with organizing pneumonia (OP) associated with rheumatoid arthritis (RA) or related to biological disease-modifying antirheumatic drugs (DMARDs) at our institution between 2006 and 2014. Among these cases, 3 (14.3%) preceded articular symptoms of RA, 4 (19.0%) developed simultaneously with RA onset, and 14 (66.7%) occurred during follow-up periods for RA. In the case of OP preceding RA, increased levels of anti-cyclic citrullinated peptide antibodies and rheumatoid factor were observed at the OP onset. RA disease activity was related to the development of OP in the simultaneous cases. In the cases of OP developing after RA diagnosis, 10 of 14 patients had maintained low disease activity with biological DMARD therapy at the OP onset, and among them, 6 patients developed OP within the first year of this therapy. In the remaining four patients, RA activity was not controlled at the OP onset. All patients responded well to systemic steroid therapy, but two patients suffered from relapses of articular and pulmonary symptoms upon steroid tapering. In most of the RA patients, DMARD therapy was introduced or restarted during the steroid tapering. We successfully restarted a biological DMARD that had not been previously used for patients whose RA would otherwise have been difficult to control. In this study, we also perform a review of the literature on RA-associated or biological DMARD-related OP and discuss the pathogenesis and management of OP occurring in RA patients.
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Affiliation(s)
- Shunsuke Mori
- Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, NHO Kumamoto Saishunsou National Hospital, Kumamoto, Japan
| | - Yukinori Koga
- Department of Radiology, Clinical Research Center for Rheumatic Diseases, NHO Kumamoto Saishunsou National Hospital, Kumamoto, Japan
| | - Mineharu Sugimoto
- Division of Respiratory Medicine, Department of Medicine, NHO Kumamoto Saishunsou National Hospital, Kumamoto, Japan
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Rojas CML, Borella E, Palma L, Ragozzino S, De Ramón E, Gomez-Huelgas R, Punzi L, Doria A. Bronchiolitis obliterans organizing pneumonia in patients with autoimmune rheumatic diseases. Immunol Res 2015; 61:97-103. [PMID: 25480740 DOI: 10.1007/s12026-014-8607-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Bronchiolitis obliterans organizing pneumonia (BOOP) is defined by buds of granulation tissue within lung distal airspaces. The diagnosis requires the histopathologic evidence of organizing pneumonia along with a suggestive clinical and radiographic pattern. This disorder is characterized by a good response to corticosteroids and an excellent prognosis. It can occur in association with a broad spectrum of clinical conditions or can be isolated, in this last case named cryptogenic organizing pneumonia. We searched for BOOP in patients with autoimmune rheumatic diseases (ARD) in the literature, and we found 32 well-documented cases. We reported here demographic features, manifestations, treatment and outcome of patients with BOOP associated with ARD. Notably, BOOP can be the presenting feature in some patients with ARD; thus, a close follow-up of patients with BOOP is recommended.
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Affiliation(s)
- Carmen Maria Lara Rojas
- Internal Medicine Department, Biomedical Institute of Malaga (IBIMA), University Hospitals, Regional and Clinical Virgen de la Victoria of Malaga, Málaga, Spain
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Mori S. Management of Rheumatoid Arthritis Patients with Interstitial Lung Disease: Safety of Biological Antirheumatic Drugs and Assessment of Pulmonary Fibrosis. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2015; 9:41-9. [PMID: 26401101 PMCID: PMC4564070 DOI: 10.4137/ccrpm.s23288] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/04/2015] [Accepted: 08/06/2015] [Indexed: 02/07/2023]
Abstract
Interstitial lung disease (ILD) is one of the major causes of morbidity and mortality of patients with rheumatoid arthritis (RA). Accompanying the increased number of reports on the development or exacerbation of ILD in RA patients following therapy with biological disease-modifying antirheumatic drugs (DMARDs), RA-associated ILD (RA-ILD) has aroused renewed interest. Although such cases have been reported mainly in association with the use of tumor necrosis factor inhibitors, the use of other biological DMARDs has also become a matter of concern. Nevertheless, it is difficult to establish a causative relationship between the use of biological DMARDs and either the development or exacerbation of ILD. Such pulmonary complications may occur in the natural course of RA regardless of the use of biological DMARDs. Since rheumatologists currently aim to achieve remission in RA patients, the administration of biological DMARDs is increasing, even for those with RA-ILD. However, there are no reliable, evidence-based guidelines for deciding whether biological DMARDs can be safely introduced and continued in RA-ILD patients. A standardized staging system for pulmonary conditions of RA-ILD patients is needed when making therapeutic decisions at baseline and monitoring during biological DMARD therapy. Based on the available information regarding the safety of biological DMARDs and the predictive factors for a worse prognosis, this review discusses candidate parameters for risk evaluation of ILD in RA patients who are scheduled to receive biological antirheumatic therapy.
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Affiliation(s)
- Shunsuke Mori
- Department of Rheumatology, Clinical Research Center for Rheumatic Diseases, NHO Kumamoto Saishunsou National Hospital, Kumamoto, Japan
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10
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Abstract
Interstitial lung disease (ILD) is a common extra-articular manifestation associated with increased morbidity and mortality in patients with rheumatoid arthritis (RA). Early case reports of serious respiratory adverse events (SRAEs) following treatment with anti-TNF agents have led to concerns about biologic therapy in patients with RA-associated ILD (RA-ILD), and a tendency for biologic agents targeting factors other than TNF to be prescribed in such patients. At present, the appropriateness of such decisions is not clear. Given that the therapeutic goal for RA is remission, clinicians increasingly face the challenge of choosing the optimal biologic agent in patients with RA-ILD and uncontrolled joint disease. However, no evidence-based guidelines exist to guide physicians in deciding whether to commence biologic therapy in this setting, or in selecting which drug is most appropriate. Herein, we review the evidence for the comparative pulmonary safety of anti-TNF agents and non-TNF-targeting biologic agents in RA-ILD. In addition, we propose a framework for assessment of baseline disease severity to guide treatment decisions, and for monitoring during therapy. Because of substantial gaps in the available evidence, we also describe a research agenda aimed at obtaining data that will help inform future clinical practice.
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Roubille C, Haraoui B. Interstitial lung diseases induced or exacerbated by DMARDS and biologic agents in rheumatoid arthritis: a systematic literature review. Semin Arthritis Rheum 2013; 43:613-26. [PMID: 24231065 DOI: 10.1016/j.semarthrit.2013.09.005] [Citation(s) in RCA: 171] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 09/25/2013] [Accepted: 09/29/2013] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To review published cases of induced or exacerbated interstitial lung disease (ILD) in rheumatoid arthritis (RA) associated with non-biologic disease-modifying antirheumatic drugs (nbDMARDs) and biologics and to discuss clinical implications in daily practice. METHODS We performed a systematic literature review from 1975 to July 2013 using Medline, Embase, Cochrane, and abstracts from the ACR 2010-2012 and EULAR 2010-2013 annual meetings. Case reports and series that suggest a causative role of nbDMARDs (methotrexate [MTX], leflunomide [LEF], gold, azathioprine [AZA], sulfasalazine [SSZ], and hydroxychloroquine [HCQ]) and biologic agents (TNF inhibitors [TNFi], rituximab [RTX], tocilizumab [TCZ], abatacept [ABA], and anakinra) in causing ILD or worsening a pre-existing ILD in RA patients were included. Results from observational and postmarketing studies as well as reviews on this topic were excluded from the qualitative analysis but still considered to discuss the implication of such drugs in generating or worsening ILD in RA patients. Comparisons were made between MTX-induced ILD in RA and the cases reported with other agents, in terms of clinical presentation, radiological features, and therapeutic management and outcomes. RESULTS The literature search identified 32 articles for MTX, 12 for LEF (resulting in 34 case reports), 3 for gold, 1 for AZA, 4 for SSZ, 27 for TNFi (resulting in 31 case reports), 3 for RTX, 5 for TCZ (resulting in 8 case reports), and 1 for ABA. No case was found for HCQ or anakinra. Common points are noted between LEF- and TNFi-related ILD in RA: ILD is a rare severe adverse event, mostly occurs within the first 20 weeks after initiation of therapy, causes dyspnea mostly in older patients, and can be fatal. Although no definitive causative relationship can be drawn from case reports and observational studies, these data argue for a pulmonary follow-up in RA patients with pre-existing ILD, while receiving biologic therapy or nbDMARDs. CONCLUSION As previously described for MTX, growing evidence highlights that LEF, TNFi, RTX, and TCZ may induce pneumonitis or worsen RA-related pre-existing ILD. Nonetheless, identifying a causal relationship between RA therapy and ILD-induced toxicity clearly appears difficult, partly because it is a rare condition.
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Affiliation(s)
- Camille Roubille
- Osteoarthritis Research Unit, University of Montreal Hospital Research Center (CRCHUM), Notre-Dame Hospital, Montreal, Quebec, Canada
| | - Boulos Haraoui
- Department of Medicine, Rheumatic Disease Unit, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Institut de rhumatologie de Montréal, 1551 Ontario St East, Montreal, Quebec, Canada H2L 1S6.
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