Efficacy and Safety of Rituximab in Autoimmune Disease—Associated Interstitial Lung Disease: A Prospective Cohort Study

Abstract

Objectives: To analyze the efficacy and safety of rituximab (RTX) in connective tissue disease associated with interstitial lung disease (CTD-ILD). Methods: We performed a multicenter, prospective, observational study of patients with CTD-ILD receiving rituximab between 2015 and 2020. The patients were assessed using high-resolution computed tomography and pulmonary function tests at baseline, at 12 months, and at the end of follow-up. The main outcome measure at the end of follow-up was forced vital capacity (FVC) > 10% or diffusing capacity of the lungs for carbon monoxide (DLCO) > 15% and radiological progression or death. We recorded clinical characteristics, time to initiation of RTX, concomitant treatment, infections, and hospitalization. A Cox regression analysis was performed to identify factors associated with worsening ILD. Results: We included 37 patients with CTD-ILD treated with RTX for a median (IQR) of 38.2 (17.7–69.0) months. At the end of the follow-up, disease had improved or stabilized in 23 patients (62.1%) and worsened in seven (18.9%); seven patients (18.9%) died. No significant decline was observed in median FVC (72.2 vs. 70.8; p = 0.530) or DLCO (55.9 vs. 52.2; p = 0.100). The multivariate analysis showed the independent predictors for worsening of CTD-ILD to be baseline DLCO (OR (95% CI), 0.904 (0.8–0.9); p = 0.015), time to initiation of RTX (1.01 (1.001–1.02); p = 0.029), and mycophenolate (0.202 (0.04–0.8); p = 0.034). Only 28 of the 37 patients (75.6%) were still undergoing treatment with RTX: two patients (5.4%) stopped treatment due to adverse events and seven patients (18.9%) died owing to progression of ILD and superinfection. Conclusion: Lung function improved or stabilized in more than half of patients with CTD-ILD treated with RTX. Early treatment and combination with mycophenolate could reduce the risk of progression of ILD.

Novel Biomarkers, Diagnostic and Therapeutic Approach in Rheumatoid Arthritis Interstitial Lung Disease—A Narrative Review

“…Rituximab, tocilizumab, and abatacept have all been shown to have favorable results in recent studies, with the disease in treated individuals maintaining constant or improving as measured by PFTs. However, most of these investigations are small, uncontrolled retrospective studies, and their findings must be confirmed in RCTs [ 99 , 100 , 101 ].…”

CAR-T-Zell-Therapie bei autoimmunen Erkrankungen

“…Weitere Zulassungen für andere Autoimmunerkrankungen, wie den ANCA-assoziierten Vaskulitiden oder dem Pemphigus vulgaris, folgten. Darüber hinaus hat es auch einen hohen Stellenwert in der Therapie der Kollagenosen, insbesondere bei schweren Manifestationen und interstitieller Lungen erkrankung [17]. Allerdings profitieren nicht alle Patienten gleichermaßen, wie nicht zuletzt die hinter den Erwartungen zurückbleibenden Phase-II/III-Studien zu Rituximab und SLE demonstrierten [18,19].…”

Efficacy of non-conventional synthetic DMARDs for patients with rheumatoid arthritis-associated interstitial lung disease: a systematic review and meta-analysis

“…A total of 17 clinical studies with 1315 adult patients with RA-ILD were included, all of which were self-controlled studies. The studies were conducted in seven different countries, more precisely four in Spain, [19][20][21][22] five in Italy, [23][24][25][26][27] one in Greece, 28 four in Britain, [29][30][31][32] one in South Korea, 33 one in Japan 34 and one in the USA. 35 The age range of patients was 49-83 years, and the follow-up time was approximately 6-70 months.…”