Tocilizumab therapy in rheumatoid arthritis with interstitial lung disease: a multicentre retrospective study

Andreina Manfredi; Giulia Cassone; Federica Furini; Elisa Gremese; Vincenzo Venerito; Fabiola Atzeni; Eugenio Arrigoni; Giovanni Della Casa; Stefania Cerri; Marcello Govoni; Luca Petricca; Florenzo Iannone; Carlo Salvarani; Marco Sebastiani

doi:10.1111/imj.14670

Tocilizumab therapy in rheumatoid arthritis with interstitial lung disease: a multicentre retrospective study

Andreina Manfredi, Giulia Cassone, Federica Furini, Elisa Gremese, Vincenzo Venerito, Fabiola Atzeni, Eugenio Arrigoni, Giovanni Della Casa, Stefania Cerri, Marcello Govoni, Luca Petricca, Florenzo Iannone, Carlo Salvarani, Marco Sebastiani

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Interstitial lung disease (ILD) is the most severe extra-articular manifestation of rheumatoid arthritis (RA). Although it is responsible of 10-20% of all RA mortality, no controlled studies are available for the treatment of RA-ILD and its therapeutic approach is still debated.

AIMS: To analyse the evolution of ILD in a population of RA patients treated with tocilizumab (TCZ).

METHODS: In this national multicentre study, we retrospectively collected patients with RA-ILD treated with at least one dose of TCZ. For each patient, disease activity and serological data were evaluated. Moreover, we analysed the evolution of high-resolution computed tomography (HRCT) and pulmonary function tests, including forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO).

RESULTS: Twenty-eight RA-ILD patients were identified (females/males 18/10, mean age 61.6 years), with a mean follow up for TCZ therapy of 30 months. At the end of follow up, FVC remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%). DLCO remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%), even though in 3 patients DLCO and FVC showed an opposite trend. HRCT remained stable in the majority (25) of cases, worsened in two patients with a usual interstitial pneumonia pattern and improved in only one case with a non-specific interstitial pneumonia pattern.

CONCLUSIONS: The management of RA-ILD patients remains a critical unmet need. TCZ demonstrated a good safety profile in patients with RA-ILD and a potential effect on the stabilisation of lung involvement.

Original language	English
Pages (from-to)	1085-1090
Number of pages	6
Journal	Internal Medicine Journal
Volume	50
Issue number	9
DOIs	https://doi.org/10.1111/imj.14670
Publication status	Published - Sep 2020

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Manfredi, A., Cassone, G., Furini, F., Gremese, E., Venerito, V., Atzeni, F., Arrigoni, E., Della Casa, G., Cerri, S., Govoni, M., Petricca, L., Iannone, F., Salvarani, C., & Sebastiani, M. (2020). Tocilizumab therapy in rheumatoid arthritis with interstitial lung disease: a multicentre retrospective study. Internal Medicine Journal, 50(9), 1085-1090. https://doi.org/10.1111/imj.14670

Manfredi, A, Cassone, G, Furini, F, Gremese, E, Venerito, V, Atzeni, F, Arrigoni, E, Della Casa, G, Cerri, S, Govoni, M, Petricca, L, Iannone, F, Salvarani, C & Sebastiani, M 2020, 'Tocilizumab therapy in rheumatoid arthritis with interstitial lung disease: a multicentre retrospective study', Internal Medicine Journal, vol. 50, no. 9, pp. 1085-1090. https://doi.org/10.1111/imj.14670

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title = "Tocilizumab therapy in rheumatoid arthritis with interstitial lung disease: a multicentre retrospective study",

abstract = "BACKGROUND: Interstitial lung disease (ILD) is the most severe extra-articular manifestation of rheumatoid arthritis (RA). Although it is responsible of 10-20% of all RA mortality, no controlled studies are available for the treatment of RA-ILD and its therapeutic approach is still debated.AIMS: To analyse the evolution of ILD in a population of RA patients treated with tocilizumab (TCZ).METHODS: In this national multicentre study, we retrospectively collected patients with RA-ILD treated with at least one dose of TCZ. For each patient, disease activity and serological data were evaluated. Moreover, we analysed the evolution of high-resolution computed tomography (HRCT) and pulmonary function tests, including forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO).RESULTS: Twenty-eight RA-ILD patients were identified (females/males 18/10, mean age 61.6 years), with a mean follow up for TCZ therapy of 30 months. At the end of follow up, FVC remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%). DLCO remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%), even though in 3 patients DLCO and FVC showed an opposite trend. HRCT remained stable in the majority (25) of cases, worsened in two patients with a usual interstitial pneumonia pattern and improved in only one case with a non-specific interstitial pneumonia pattern.CONCLUSIONS: The management of RA-ILD patients remains a critical unmet need. TCZ demonstrated a good safety profile in patients with RA-ILD and a potential effect on the stabilisation of lung involvement.",

author = "Andreina Manfredi and Giulia Cassone and Federica Furini and Elisa Gremese and Vincenzo Venerito and Fabiola Atzeni and Eugenio Arrigoni and {Della Casa}, Giovanni and Stefania Cerri and Marcello Govoni and Luca Petricca and Florenzo Iannone and Carlo Salvarani and Marco Sebastiani",

note = "{\textcopyright} 2019 Royal Australasian College of Physicians.",

year = "2020",

month = sep,

doi = "10.1111/imj.14670",

language = "English",

volume = "50",

pages = "1085--1090",

journal = "Internal Medicine Journal",

issn = "1444-0903",

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TY - JOUR

T1 - Tocilizumab therapy in rheumatoid arthritis with interstitial lung disease

T2 - a multicentre retrospective study

AU - Manfredi, Andreina

AU - Cassone, Giulia

AU - Furini, Federica

AU - Gremese, Elisa

AU - Venerito, Vincenzo

AU - Atzeni, Fabiola

AU - Arrigoni, Eugenio

AU - Della Casa, Giovanni

AU - Cerri, Stefania

AU - Govoni, Marcello

AU - Petricca, Luca

AU - Iannone, Florenzo

AU - Salvarani, Carlo

AU - Sebastiani, Marco

PY - 2020/9

Y1 - 2020/9

N2 - BACKGROUND: Interstitial lung disease (ILD) is the most severe extra-articular manifestation of rheumatoid arthritis (RA). Although it is responsible of 10-20% of all RA mortality, no controlled studies are available for the treatment of RA-ILD and its therapeutic approach is still debated.AIMS: To analyse the evolution of ILD in a population of RA patients treated with tocilizumab (TCZ).METHODS: In this national multicentre study, we retrospectively collected patients with RA-ILD treated with at least one dose of TCZ. For each patient, disease activity and serological data were evaluated. Moreover, we analysed the evolution of high-resolution computed tomography (HRCT) and pulmonary function tests, including forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO).RESULTS: Twenty-eight RA-ILD patients were identified (females/males 18/10, mean age 61.6 years), with a mean follow up for TCZ therapy of 30 months. At the end of follow up, FVC remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%). DLCO remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%), even though in 3 patients DLCO and FVC showed an opposite trend. HRCT remained stable in the majority (25) of cases, worsened in two patients with a usual interstitial pneumonia pattern and improved in only one case with a non-specific interstitial pneumonia pattern.CONCLUSIONS: The management of RA-ILD patients remains a critical unmet need. TCZ demonstrated a good safety profile in patients with RA-ILD and a potential effect on the stabilisation of lung involvement.

AB - BACKGROUND: Interstitial lung disease (ILD) is the most severe extra-articular manifestation of rheumatoid arthritis (RA). Although it is responsible of 10-20% of all RA mortality, no controlled studies are available for the treatment of RA-ILD and its therapeutic approach is still debated.AIMS: To analyse the evolution of ILD in a population of RA patients treated with tocilizumab (TCZ).METHODS: In this national multicentre study, we retrospectively collected patients with RA-ILD treated with at least one dose of TCZ. For each patient, disease activity and serological data were evaluated. Moreover, we analysed the evolution of high-resolution computed tomography (HRCT) and pulmonary function tests, including forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO).RESULTS: Twenty-eight RA-ILD patients were identified (females/males 18/10, mean age 61.6 years), with a mean follow up for TCZ therapy of 30 months. At the end of follow up, FVC remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%). DLCO remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%), even though in 3 patients DLCO and FVC showed an opposite trend. HRCT remained stable in the majority (25) of cases, worsened in two patients with a usual interstitial pneumonia pattern and improved in only one case with a non-specific interstitial pneumonia pattern.CONCLUSIONS: The management of RA-ILD patients remains a critical unmet need. TCZ demonstrated a good safety profile in patients with RA-ILD and a potential effect on the stabilisation of lung involvement.

U2 - 10.1111/imj.14670

DO - 10.1111/imj.14670

M3 - Article

C2 - 31661185

VL - 50

SP - 1085

EP - 1090

JO - Internal Medicine Journal

JF - Internal Medicine Journal

SN - 1444-0903

IS - 9

ER -

Tocilizumab therapy in rheumatoid arthritis with interstitial lung disease: a multicentre retrospective study

Abstract

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