Tags

Type your tag names separated by a space and hit enter

Rituximab in connective tissue disease-associated interstitial lung disease.
Clin Rheumatol. 2019 Jul; 38(7):2001-2009.CR

Abstract

INTRODUCTION/OBJECTIVES

To evaluate rituximab (RTX) effectiveness and safety in patients with interstitial lung disease (ILD) related to connective tissue diseases (CTD).

METHODS

Retrospective multicenter cohort study, including patients with CTD-ILD, followed in six Portuguese rheumatology departments until November 2018. ILD diagnosis was based on high-resolution CT (HRCT) and/or lung biopsy. Results of HRCT, pulmonary function tests, and 6-min walking test before and after RTX were compared using the Wilcoxon matched pair test. Safety, including adverse events during treatment and reasons for RTX discontinuation, was also analyzed.

RESULTS

A total of 49 patients were included, with rheumatoid arthritis being the commonest CTD (61.2%). The median interval between CTD onset and ILD diagnosis was 4 years (IQR 1-9.5) and median ILD duration at first RTX administration was 1 year (IQR 0-4). The median RTX treatment duration until the last follow-up was 3 years (IQR 1-6). Usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP) were the commonest patterns, occurring in 20 and 18 patients, respectively. One year after RTX first administration, there was a stabilization in carbon monoxide diffusing capacity (DLCO; mean + 5.4%, p = 0.12) and improvement in forced vital capacity (FVC; mean + 4.3%, p = 0.03), particularly in patients with NSIP. Patients with UIP had less promising results, but at 1 year, pulmonary function tests remained stable (DLCO + 2.5%, p = 0.77; FVC + 4.2%, p = 0.16). Infection was the main reason for RTX discontinuation and led to two deaths.

CONCLUSIONS

RTX seems to be a promising treatment for CTD-ILD patients, particularly when NSIP pattern is present. Key points • The use of rituximab in patients with interstitial lung disease related to connective tissue disease is associated with long-standing disease stability in a wide range of systemic rheumatic diseases. • Efficacy results were particularly impressive in patients with non-specific interstitial pneumonia pattern, although in a subgroup of patients with usual interstitial pneumonia pattern, disease progression was also hold with this treatment. • In a large number of patients, rituximab was used in monotherapy and as first-line treatment.

Authors+Show Affiliations

Rheumatology Department, Hospital Garcia de Orta EPE, Avenida Torrado da Silva, 2805-267, Almada, Portugal. catarinaduarte89@gmail.com.Rheumatology Department, Hospital Garcia de Orta EPE, Avenida Torrado da Silva, 2805-267, Almada, Portugal.Rheumatology Department, Centro Hospitalar Universitário de São João EPE, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.Rheumatology Department, Centro Hospitalar Universitário de São João EPE, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte EPE, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal. Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal.Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte EPE, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal. Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal.Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, Quinta dos Vales, São Martinho do Bispo 108, 3041-801, Coimbra, Portugal. Faculty of Medicine, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal.Rheumatology Unit, Centro Hospitalar Tondela-Viseu EPE, Avenida Rei Dom Duarte, 3500, Viseu, Portugal.Rheumatology Unit, Hospital de Braga, Sete Fontes - São Victor, 4710-243, Braga, Portugal.Rheumatology Department, Hospital Garcia de Orta EPE, Avenida Torrado da Silva, 2805-267, Almada, Portugal. Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

31016581

Citation

Duarte, Ana Catarina, et al. "Rituximab in Connective Tissue Disease-associated Interstitial Lung Disease." Clinical Rheumatology, vol. 38, no. 7, 2019, pp. 2001-2009.
Duarte AC, Cordeiro A, Fernandes BM, et al. Rituximab in connective tissue disease-associated interstitial lung disease. Clin Rheumatol. 2019;38(7):2001-2009.
Duarte, A. C., Cordeiro, A., Fernandes, B. M., Bernardes, M., Martins, P., Cordeiro, I., Santiago, T., Seixas, M. I., Ribeiro, A. R., & Santos, M. J. (2019). Rituximab in connective tissue disease-associated interstitial lung disease. Clinical Rheumatology, 38(7), 2001-2009. https://doi.org/10.1007/s10067-019-04557-7
Duarte AC, et al. Rituximab in Connective Tissue Disease-associated Interstitial Lung Disease. Clin Rheumatol. 2019;38(7):2001-2009. PubMed PMID: 31016581.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rituximab in connective tissue disease-associated interstitial lung disease. AU - Duarte,Ana Catarina, AU - Cordeiro,Ana, AU - Fernandes,Bruno Miguel, AU - Bernardes,Miguel, AU - Martins,Patrícia, AU - Cordeiro,Inês, AU - Santiago,Tânia, AU - Seixas,Maria Inês, AU - Ribeiro,Ana Roxo, AU - Santos,Maria José, Y1 - 2019/04/23/ PY - 2019/03/09/received PY - 2019/04/09/accepted PY - 2019/4/25/pubmed PY - 2019/12/18/medline PY - 2019/4/25/entrez KW - Connective tissue disease KW - Interstitial lung disease KW - Non-specific interstitial pneumonia KW - Rituximab KW - Usual interstitial pneumonia SP - 2001 EP - 2009 JF - Clinical rheumatology JO - Clin. Rheumatol. VL - 38 IS - 7 N2 - INTRODUCTION/OBJECTIVES: To evaluate rituximab (RTX) effectiveness and safety in patients with interstitial lung disease (ILD) related to connective tissue diseases (CTD). METHODS: Retrospective multicenter cohort study, including patients with CTD-ILD, followed in six Portuguese rheumatology departments until November 2018. ILD diagnosis was based on high-resolution CT (HRCT) and/or lung biopsy. Results of HRCT, pulmonary function tests, and 6-min walking test before and after RTX were compared using the Wilcoxon matched pair test. Safety, including adverse events during treatment and reasons for RTX discontinuation, was also analyzed. RESULTS: A total of 49 patients were included, with rheumatoid arthritis being the commonest CTD (61.2%). The median interval between CTD onset and ILD diagnosis was 4 years (IQR 1-9.5) and median ILD duration at first RTX administration was 1 year (IQR 0-4). The median RTX treatment duration until the last follow-up was 3 years (IQR 1-6). Usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP) were the commonest patterns, occurring in 20 and 18 patients, respectively. One year after RTX first administration, there was a stabilization in carbon monoxide diffusing capacity (DLCO; mean + 5.4%, p = 0.12) and improvement in forced vital capacity (FVC; mean + 4.3%, p = 0.03), particularly in patients with NSIP. Patients with UIP had less promising results, but at 1 year, pulmonary function tests remained stable (DLCO + 2.5%, p = 0.77; FVC + 4.2%, p = 0.16). Infection was the main reason for RTX discontinuation and led to two deaths. CONCLUSIONS: RTX seems to be a promising treatment for CTD-ILD patients, particularly when NSIP pattern is present. Key points • The use of rituximab in patients with interstitial lung disease related to connective tissue disease is associated with long-standing disease stability in a wide range of systemic rheumatic diseases. • Efficacy results were particularly impressive in patients with non-specific interstitial pneumonia pattern, although in a subgroup of patients with usual interstitial pneumonia pattern, disease progression was also hold with this treatment. • In a large number of patients, rituximab was used in monotherapy and as first-line treatment. SN - 1434-9949 UR - https://www.unboundmedicine.com/medline/citation/31016581/Rituximab_in_connective_tissue_disease_associated_interstitial_lung_disease_ L2 - https://dx.doi.org/10.1007/s10067-019-04557-7 DB - PRIME DP - Unbound Medicine ER -