Rituximab for the treatment of connective tissue disease-associated interstitial lung disease

• Published in: Sarcoidosis, vasculitis, and diffuse lung diseases Vol. 32; no. 4; p. 296
• Main Authors: Chartrand, Sandra, Swigris, Jeffrey J, Peykova, Lina, Fischer, Aryeh
• Format: Journal Article
• Language: English
• Published: Italy 15.01.2016
• Subjects: Aged; Connective Tissue Diseases - complications; Connective Tissue Diseases - diagnosis; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; Lung - drug effects; Lung - pathology; Lung - physiopathology; Lung Diseases, Interstitial - diagnosis; Lung Diseases, Interstitial - drug therapy; Lung Diseases, Interstitial - etiology; Lung Diseases, Interstitial - physiopathology; Male; Middle Aged; Retrospective Studies; Rituximab - adverse effects; Rituximab - therapeutic use; Time Factors; Treatment Outcome; Vital Capacity
• ISSN: 1124-0490

To describe our experience with rituximab (RTX) as treatment for a diverse spectrum of chronic connective tissue disease-associated interstitial lung disease (CTD-ILD). Twenty-four subjects with CTD-ILD were included. All had pulmonary function testing before and after their first RTX infusion. Each subject was evaluated in a multidisciplinary autoimmune and ILD outpatient clinic. Data were extracted by retrospective review of complete medical records. Most subjects were middle-aged white women with rheumatoid arthritis (RA) (n=15) and a nonspecific interstitial pneumonia (NSIP) pattern on high-resolution chest computed tomography scans (n=17). Sixteen subjects received a corticosteroid-sparing agent at the time of RTX initiation; mostly mycophenolate mofetil (n=8). RTX administration was not associated with corticosteroid-sparing effects: 13 subjects were on prednisone at the time of the initial RTX cycle, and 9 remained on prednisone at 6 months after (mean daily dosage 10.2±16.2 mg before vs. 5.6±11.0 mg after, p=0.27). RTX had no appreciable effect on pulmonary physiology; however, individual trajectories for percentage predicted forced vital capacity (FVC%) were highly variable. The underlying CTD (RA vs. non-RA) and ILD pattern did not appear to affect response to RTX. Among 14 subjects who received multiple RTX cycles, FVC% trajectories were variable: FVC% increased in eight and declined in six. Respiratory infections were the most common post-RTX adverse event. In this small, retrospective study of chronic CTD-ILD, RTX was not associated with changes in FVC% or corticosteroid-sparing effects. Controlled, prospective studies are needed to more confidently define the effects of RTX in CTD-ILD.