Drug-Induced Interstitial Lung Disease: A Systematic Review

Abstract

Background: Drug-induced interstitial lung disease (DIILD) occurs as a result of numerous agents, but the risk often only becomes apparent after the marketing authorisation of such agents. Methods: In this PRISMA-compliant systematic review, we aimed to evaluate and synthesise the current literature on DIILD. Results: Following a quality assessment, 156 full-text papers describing more than 6000 DIILD cases were included in the review. However, the majority of the papers were of low or very low quality in relation to the review question (78%). Thus, it was not possible to perform a meta-analysis, and descriptive review was undertaken instead. DIILD incidence rates varied between 4.1 and 12.4 cases/million/year. DIILD accounted for 3–5% of prevalent ILD cases. Cancer drugs, followed by rheumatology drugs, amiodarone and antibiotics, were the most common causes of DIILD. The radiopathological phenotype of DIILD varied between and within agents, and no typical radiological pattern specific to DIILD was identified. Mortality rates of over 50% were reported in some studies. Severity at presentation was the most reliable predictor of mortality. Glucocorticoids (GCs) were commonly used to treat DIILD, but no prospective studies examined their effect on outcome. Conclusions: Overall high-quality evidence in DIILD is lacking, and the current review will inform larger prospective studies to investigate the diagnosis and management of DIILD.

HRCT Patterns of Drug-Induced Interstitial Lung Diseases: A Review

“…The first case of heroin pulmonary toxicity was described by Osler in 1880; in years, a huge number of substances and drugs associated with possible DILD was observed and more than 350 different drugs are associated with iatrogenic lung diseases [26].…”

“…Chronic toxicity, which is associated with continued use of the drug and does not appear to be correlated with previous acute events, is more frequently represented by irreversible pulmonary fibrosis; less frequently, Organizing Pneumonia (OP) patterns can also occur [26,27]. Sulfalazina, which is used in inflammatory bowel disease and rheumatoid arthritis, is rarely associated with obliterating bronchiolitis and fibrosing alveolitis, and fatal cases have been reported [28].…”

Drug-Induced Interstitial Pneumonia due to Application of FOLFOX as Adjuvant Chemotherapy after Rectal Cancer Surgery: A Case Report and Literature Review

“…It is often difficult to differentiate DI-IP from other lung diseases and thus, DI-IP diagnosis remains a challenge. While TBLB or BAL may be helpful in DI-IP diagnosis, the accuracy rate of these diagnostic procedures is not high and they could only rule out other causes [7]. Steroid therapy is generally used for DI-IP; however, no prospective studies have examined the outcomes of such a therapy in these patients [7].…”

Therapies in Inflammatory Bowel Disease Patients with Extraintestinal Manifestations

“…Pulmonary involvement exists with reports involving different parts of the bronchial tree from the glottis to small airways. In particular, interstitial pneumonitis has been suggested 20-55% of IBD patients [131], the most frequent remaining drug induced (5-ASA compounds, methotrexate, or anti-TNF alpha agents) [132] and infections. IBD patients are at increased risk of cardiovascular events (mainly ve-Digestion 2020;101(suppl 1):83-97 DOI: 10.1159/000502816 nous and arterial thromboembolism, myocardial infarction) which are more linked to the chronic inflammatory pattern of the disease and less to very rare associated cardiovascular diseases [25,133].…”