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23.04.2019 | Original Article

Rituximab in connective tissue disease–associated interstitial lung disease

verfasst von: Ana Catarina Duarte, Ana Cordeiro, Bruno Miguel Fernandes, Miguel Bernardes, Patrícia Martins, Inês Cordeiro, Tânia Santiago, Maria Inês Seixas, Ana Roxo Ribeiro, Maria José Santos

Erschienen in: Clinical Rheumatology | Ausgabe 7/2019

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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.

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Titel: Rituximab in connective tissue disease–associated interstitial lung disease
verfasst von: Ana Catarina Duarte
Ana Cordeiro
Bruno Miguel Fernandes
Miguel Bernardes
Patrícia Martins
Inês Cordeiro
Tânia Santiago
Maria Inês Seixas
Ana Roxo Ribeiro
Maria José Santos
Publikationsdatum: 23.04.2019
Verlag: Springer London
Erschienen in: Clinical Rheumatology / Ausgabe 7/2019
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-019-04557-7

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Rituximab in connective tissue disease–associated interstitial lung disease