Exacerbation of combined pulmonary fibrosis and emphysema syndrome during tocilizumab therapy for rheumatoid arthritis

Treatment of Rheumatoid Arthritis-Associated Interstitial Lung Disease: Lights and Shadows

“…On the other hand, adverse lung effects have been also reported after the use of TCZ. In particular, Wendling described the worsening of pre-existing ILD in a patient after 23 infusions of TCZ as monotherapy and subsequent improvement of symptoms and HRCT findings after its withdrawal [146].…”

Rheumatoid arthritis-associated lung disease

“…Sulfasalazine can also cause eosinophilic pneumonia, which typically improves with drug cessation [10]. There have been a few reports of noninfectious pneumonia developing in the setting of the anti-IL6 agent tocilizumab [101,109,110], as well as reports of exacerbations of pre-existing ILD [111,112]. Abatacept, an inhibitor of T-cell co-stimulation that binds B7 (CD80 and CD86) on antigen presenting cells, has been associated with COPD exacerbations, but there has only been one report of possible ILD exacerbation described in the literature [113].…”

Tocilizumab for refractory organising pneumonia associated with Sjögren's disease

“…The treatment effect on CTD ILD has not been well established; concerning systemic sclerosis, no effect has been observed on lung fibrosis,12 but some cases of ILD improved after tocilizumab in rheumatoid arthritis (RA),13 and no effects on undifferentiated autoinflammatory disorder have been reported 14. However, concerns have been raised about pulmonary toxicity of tocilizumab in RA, since there have been several cases of exacerbation of ILD,15 16 and the appearance of ILD,17 including a case of OP,18 after this treatment. Further investigations are required to assess the role of tocilizumab as an alternative therapeutic in refractory OP.…”