Rituximab in connective tissue disease-associated interstitial lung disease

摘要

Introduction/objectivesTo evaluate rituximab (RTX) effectiveness and safety in patients with interstitial lung disease (ILD) related to connective tissue diseases (CTD).MethodsRetrospective 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.ResultsA 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 4years (IQR 1-9.5) and median ILD duration at first RTX administration was 1year (IQR 0-4). The median RTX treatment duration until the last follow-up was 3years (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 1year, 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.ConclusionsRTX seems to be a promising treatment for CTD-ILD patients, particularly when NSIP pattern is present.