Interstitial Lung Disease in a Patient Treated with Denosumab

Abstract

Denosumab is an antiresorptive agent widely used for treating osteoporosis. Atypical femur fractures, osteonecrosis of the jaw and hypocalcaemia are well-known possible adverse effects of this drug. We present, to our knowledge, the first case report in the English literature of clinically significant interstitial lung disease likely related to denosumab.

Secondary organising pneumonia caused by denosumab

“…This is widely used in clinical research and pharmacovigilance to determine the probability that an adverse effect is related to a specific drug, according to a pre-established questionnaire [ 16 ] . The score for this case report was calculated: (a) we cited two previous conclusive reports of this reaction (YES=+1), respectively, Ruis et al [ 7 ] and Mori et al [ 8 ] ; (b) the clinical event appeared 48 hours after the third injection of denosumab (YES=+2); (c) the clinical event improved with denosumab withdrawal and corticosteroid therapy (YES=+1); (d) re-administration of denosumab was not done (=0), because of ethical aspects and the severity of the ADR; (e) there are no alternative causes (e.g. infection, immunological or post radiation origin) explaining this ADR (YES=+2).…”

“…More than 2% of women treated with denosumab experienced the adverse effects [6] . Denosumab is also responsible for different aspects of pulmonary toxicity reported in the literature; two cases of diffuse interstitial lung diseases [7,8] , one case of c-ANCA vasculitis and one case of diffuse intra-alveolar haemorrhage due to p-ANCA have been described [9,1] . Descriptions of the clinical presentations for these reported cases are provided in Table 1.…”

“…Sex Age Comorbidity Clinical presentation Duration CT imaging ILD [7] F 87 -Hypertension -Atrial fibrillation -Osteoporosis…”