Non-anti-TNF biologic agents are associated with slower worsening of interstitial lung disease secondary to rheumatoid arthritis
非抗 TNF 生物制剂与继发于类风湿关节炎的间质性肺疾病的缓慢恶化相关
- 作者列表："Mena-Vázquez, Natalia","Godoy-Navarrete, Francisco Javier","Manrique-Arija, Sara","Aguilar-Hurtado, María Carmen","Romero-Barco, Carmen María","Ureña-Garnica, Inmaculada","Espildora, F","Añón-Oñate, Isabel","Pérez-Albaladejo, Lorena","Gomez-Cano, Carmen","Jimenez-Núñez, Francisco Gabriel","Padin-Martín, María Isabel","Fernández-Nebro, Antonio
Objectives To analyze the effect of disease-modifying antirheumatic drugs (DMARDs) on the outcome of interstitial lung disease secondary to rheumatoid arthritis (RA-ILD). Patients and methods We performed a multicenter, prospective, observational study of patients with RA-ILD receiving DMARDs between 2015 and 2017. The patients were assessed using high-resolution computed tomography and pulmonary function tests at baseline and at 24 months. The radiological assessment was centralized. The main outcome measure at 24 months was changed in lung function (improvement, stabilization, worsening, or death). We recorded the 28-joint Disease Activity Score 28 (DAS28) and adverse events. A logistic regression analysis was performed to identify factors associated with worsening of ILD. Results After 24 months, lung disease was stabilized in 40 patients (57.1%), improved in 8 (11.4%), and worse in 21 (30.0%). One patient (1.4%) died. The factors associated with worsening of ILD in the multivariate analysis were treatment with abatacept, tocilizumab, or rituximab (OR, 0.102 [95%CI, 0.015–0.686]), DAS28 (OR, 1.969 [95%CI, 1.005–3.857]), and smoking (OR, 6.937 [95%CI, 1.378–4.900]). During follow-up, 30 patients (42.9%) experienced an adverse event, which was severe in 12 cases (17.1%). Conclusions Lung function is stable and inflammatory activity well controlled in most patients with RA-ILD receiving treatment with DMARDs. Non-anti-TNF DMARDs reduce the risk of worsening of lung disease in 90% of patients. The inflammatory activity of RA and smoking, on the other hand, are associated with worsening. Key Points • We have performed prospectively evaluated lung and joint function in patients with RA-ILD receiving treatment with various DMARDs. • In our study, the lung function is stable and inflammatory activity well controlled in most patients with RA-ILD receiving treatment with DMARDs. • Neither csDMARDs nor anti-TNF agents were associated with a significant risk of worsening of lung disease, whereas non-anti-TNF bDMARDs could reduce the risk of worsening of lung disease. • Smoking and poor control of joint involvement were the main factors associated with worsening of lung disease.
目的分析改善病情抗风湿药物 (DMARDs) 对类风湿关节炎 (RA-ILD) 继发间质性肺病 (间质性肺病) 转归的影响。患者和方法我们对 2015 年至 2017 年期间接受 DMARDs 的 RA-ILD 患者进行了一项多中心、前瞻性、观察性研究。在基线和 24 个月时，使用高分辨率计算机断层扫描和肺功能测试对患者进行评估。放射评估是集中的。24 个月时的主要结局指标是改变肺功能 (改善、稳定、恶化或死亡)。我们记录了 28 关节疾病活动评分 28 (DAS28) 和不良事件。进行 logistic 回归分析以确定与 ILD 恶化相关的因素。结果 24 个月后，肺部疾病稳定 40 例 (57.1%)，好转 8 例 (11.4%)，加重 21 例 (30.0%)。1 例患者 (1.4%) 死亡。多变量分析中与 ILD 恶化相关的因素为阿巴西普、托珠单抗或利妥昔单抗治疗 (or，0.102 [95% CI，0.015-0.686]) 、 DAS28 (OR, 1.969 [95% CI，1.005-3.857]) 和吸烟 (OR，6.937 [95% CI，1.378-4.900])。随访期间，30 例患者 (42.9%) 发生不良事件，其中 12 例 (17.1%) 发生严重不良事件。结论大多数 RA-ILD 患者接受 DMARDs 治疗后，肺功能稳定，炎症活动控制良好。非抗 TNF DMARDs 可降低 90% 患者肺部疾病恶化的风险。另一方面，RA 的炎症活动和吸烟与恶化有关。要点 • 我们对接受各种 dmard 治疗的 RA-ILD 患者的肺和关节功能进行了前瞻性评估。•在我们的研究中，大多数接受 DMARDs 治疗的 RA-ILD 患者的肺功能稳定，炎症活动控制良好。•CsDMARDs 和抗 TNF 药物均与肺部疾病恶化的显著风险相关，而非抗 TNF bDMARDs 可降低肺部疾病恶化的风险。•吸烟和关节受累控制不良是肺部疾病恶化的主要因素。
METHODS:OBJECTIVES:To asses the clinical course in RA-related interstitial lung disease (RA-ILD) patients with and without rituximab (RTX). The influence of other variables was also evaluated. METHODS:A longitudinal multicentre study was conducted in RA diagnosed with ILD from 2007 until 2018 in Madrid. Patients were included in a registry [pNEumology RhEumatology Autoinmune diseases (NEREA)] from the time of ILD diagnosis. The main endpoint was functional respiratory impairment (FI), when there was a decline ≥5% in the predicted forced vital capacity compared with the previous one. Pulmonary function was measured at baseline and in follow-up visits every 6-12 months. The independent variable was therapy with RTX. Covariables included sociodemographic, clinical, radiological and other therapies. Survival techniques were used to estimate the incidence rate (IR) and 95% CI of functional impairment, expressed per 100 patient-semesters. Cox multivariate regression models were run to examine the influence of RTX and other covariates on FI. Results were expressed as the hazard ratio (HR) and CI. RESULTS:A total of 68 patients were included. FI occurred in 42 patients [IR 23.5 (95% CI 19, 29.1)] and 50% of them had FI within 1.75 years of an ILD diagnosis. A multivariate analysis showed that RTX exposure resulted in a lower risk of FI compared with non-exposure [HR 0.51 (95% CI 0.31, 0.85)]. Interstitial pneumonia, glucocorticoids, disease activity and duration also influenced FI. CONCLUSION:RA-ILD patients deteriorate over time, with the median time free of impairment being <2 years. Patients exposed to RTX had a higher probability of remaining free of FI compared with other therapies. Other factors have also been identified. Key words: rheumatoid arthritis, interstitial lung disease, observational study, rituximab and prognosis
METHODS:The safety of anti-programmed cell death 1 (PD-1) antibody for patients with preexisting interstitial lung disease (ILD) remains unknown. The aim of this study was to evaluate the dependence of preexisting ILD on anti-PD-1 antibody-induced pneumonitis in non-small cell lung cancer (NSCLC) patients. We retrospectively reviewed the association of preexisting ILD with the incidence, radiographic pattern, and outcome of pneumonitis in NSCLC patients receiving anti-PD-1 antibody. A total of 331 patients were included in this study. Of these patients, 17 had preexisting ILD. The incidence of pneumonitis was higher among the patients with preexisting ILD than among those without preexisting ILD (29% vs. 10%, P = 0.027). The distributions of the CT appearances at the onset of anti-PD-1 antibody-induced pneumonitis were as follows: for the patients with preexisting ILD, two patients (40%) had diffuse alveolar damage (DAD), one patient each with organizing pneumonia-like (OP), hypersensitivity pneumonitis (HP), and other patterns (20% each); for the patients without preexisting ILD, 19 patients (61%) had OP, 8 (26%) had HP, 3 (10%) had DAD, and 1 (3.2%) had other patterns. The median onset time from the initiation of anti-PD-1 antibody treatment until the development of pneumonitis was 1.3 months (range 0.3–2.1 months) for the patients with preexisting ILD and 2.3 months (range 0.2–14.6 months) for the patients without preexisting ILD. Careful attention to the development of pneumonitis is needed, especially within the first 3 months after the start of anti-PD-1 antibody treatment, when using anti-PD-1 antibody to treat patients with preexisting ILD.
METHODS::Bacteria of the Burkholderia cepacia complex (Bcc) are ubiquitous multidrug resistant organisms and opportunistic pathogens capable of causing life threatening lung infections among cystic fibrosis (CF) patients. No effective therapies are currently available to eradicate Bcc bacteria from CF patients, as these organisms are inherently resistant to the majority of clinically available antimicrobials. An immunoproteomics approach was used to identify Bcc proteins that stimulate the humoral immune response of the CF host, using bacterial cells grown under conditions mimicking the CF lung environment and serum samples from CF patients with a clinical record of Bcc infection. 24 proteins of the Bcc strain B. cenocepacia J2315 were identified as immunoreactive, 19 here reported as immunogenic for the first time. Ten proteins were predicted as extracytoplasmic, 9 of them being conserved in Bcc genomes. The immunogenic Bcc extracytoplasmic proteins are potential targets for development of novel therapeutic strategies and diagnostic tools to protect patients against the onset of chronic Bcc lung infections.