Tocilizumab for refractory organising pneumonia associated with Sjögren's disease

Justet, A.; Ottaviani, Sébastien; Dieudé, Philippe; Taillé, Camille

doi:10.1136/bcr-2014-209076

Cited by 36 publications

(19 citation statements)

References 18 publications

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“…Case reports have shown TCZ to be effective for a variety of other diseases, including autoimmune hemolytic anemia [ 171 , 172 ], reactive arthritis [ 173 ], autoimmune encephalitis [ 174 , 175 ], myasthenia gravis [ 176 ], Blau syndrome [ 177 ], anti-Caspre2 syndrome [ 178 ], refractory organizing pneumonia associated with Sjögren’s syndrome [ 179 ], cancer-related cachexia [ 180 ] and steroid refractory immune-mediated adverse events secondary to immune check point inhibitors [ 181 ]. Besides large vessel vasculitis, several case reports have indicated that TCZ has effects on rheumatoid vasculitis [ 182 ], polyarteritis nodosa [ 183 , 184 ], microscopic polyangiitis [ 185 , 186 ] and cryoglobulinemia vasculitis [ 187 ].…”

Section: Therapeutic Targeting Of Il-6 In Diseasesmentioning

confidence: 99%

The Two-Faced Cytokine IL-6 in Host Defense and Diseases

Narazaki

Kishimoto

2018

IJMS

169

129

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Interleukein-6 (IL-6), is produced locally from infectious or injured lesions and is delivered to the whole body via the blood stream, promptly activating the host defense system to perform diverse functions. However, excessive or sustained production of IL-6 is involved in various diseases. In diseases, the IL-6 inhibitory strategy begins with the development of the anti-IL-6 receptor antibody, tocilizumab (TCZ). This antibody has shown remarkable effects on Castleman disease, rheumatoid arthritis and juvenile idiopathic arthritis. In 2017, TCZ was proven to work effectively against giant cell arteritis, Takayasu arteritis and cytokine releasing syndrome, initiating a new era for the treatment of these diseases. In this study, the defensive functions of IL-6 and various pathological conditions are compared. Further, the diseases of which TCZ has been approved for treatment are summarized, the updated results of increasing off-label use of TCZ for various diseases are reviewed and the conditions for which IL-6 inhibition might have a beneficial role are discussed. Given the involvement of IL-6 in many pathologies, the diseases that can be improved by IL-6 inhibition will expand. However, the important role of IL-6 in host defense should always be kept in mind in clinical practice.

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Section: Therapeutic Targeting Of Il-6 In Diseasesmentioning

confidence: 99%

The Two-Faced Cytokine IL-6 in Host Defense and Diseases

Narazaki

Kishimoto

2018

IJMS

169

129

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“…In refractory organising pneumonia, immunosuppressive agents such as azathioprine, cyclosporine, infliximab and rituximab have been used [113]. Recently, one case of refractory organising pneumonia was treated by tocilizumab with good efficacy [114].…”

Section: Organising Pneumonitismentioning

confidence: 99%

Pulmonary manifestations of Sjögren's syndrome

et al. 2016

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In 9–20% of cases, Sjögren's syndrome is associated with various respiratory symptoms. The most typical manifestations are chronic interstitial lung disease (ILD) and tracheobronchial disease. The most common manifestation of ILD is nonspecific interstitial pneumonia in its fibrosing variant. Other types of ILD, such as organising pneumonia, usual interstitial pneumonia and lymphocytic interstitial pneumonitis, are rare. Their radiological presentation is less distinctive, and definitive diagnosis may require the use of transbronchial or surgical lung biopsy. Corticosteroid therapy is the mainstay of ILD treatment in Sjögren's syndrome, but the use of other immunosuppressive drugs needs to be determined. ILD is a significant cause of death in Sjögren's syndrome. Tracheobronchial disease is common in Sjögren's syndrome, characterised by diffuse lymphocytic infiltration of the airway. It is sometimes responsible for a crippling chronic cough. It can also present in the form of bronchial hyperresponsiveness, bronchiectasis, bronchiolitis or recurrent respiratory infections. The management of these manifestations may require treatment for dryness and/or inflammation of the airways. Airway disease has little effect on respiratory function and is rarely the cause of death in Sjögren's syndrome patients. Rare respiratory complications such as amyloidosis, lymphoma or pulmonary hypertension should not be disregarded in Sjögren's syndrome patients.

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“…Series of OP associated with rheumatoid arthritis have described good results when treated with methotrexate, cyclophosphamide and azathioprine [24]. Others series show that tocilizumab could be a therapeutic alternative in refractory OP associated with systemic lupus erythematosus (SLE) [23, 25]. Relapses are common upon corticosteroid dose reduction or treatment suspension, thus often leading to prolonged treatment [26–28].…”

Section: Discussionmentioning

confidence: 99%

Surgical management of organizing pneumonia: a retrospective study of 24 cases in a single Centre

Meng

et al. 2019

J Cardiothorac Surg

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Background Organizing pneumonia (OP) is a rare disease that is often easily misdiagnosed as a malignancy. The diagnosis of OP can prove quite challenging. Patients typically receive treatment with high-dose corticosteroids. Relapse is common if corticosteroid treatment is reduced or stopped. However, given that long-term corticosteroid treatment often results in significant side-effects, the aim of this study was to discuss the diagnosis and surgical treatment of OP. Material and methods The medical records of 24 patients with pathologically diagnosed OP between October 2007 and January 2019 were retrospectively reviewed. All patients underwent thoracic computed tomography (CT) and transbronchial biopsy or CT-guided percutaneous needle aspiration. We analysed the clinical manifestations, radiological findings, diagnostic methods, treatment, and follow-up outcomes of all patients. Results In total, 24 patients with OP were identified. The study included 17 (70.8%) men and 7 (29.2%) women, and the mean age was 61.25 ± 11.33 years (range: 31–82). The most common symptom was cough ( n = 16; 66.6%), and the most common radiological finding was consolidation ( n = 13; 54.2%) on thoracic CT. The diagnosis of OP was made by transbronchial biopsy in 11 patients (45.8%), and percutaneous needle aspiration biopsy in 13 (54.2%). We performed 11 wedge resections, 9 segmentectomy, and 4 lobectomies. Twenty patients underwent video-assisted thoracoscopic surgery (VATS), and 4 underwent thoracotomy. Complete lesion resection was obtained in all patients, and all patients were discharged from the hospital between 5 and 11 days after surgery. The mean follow-up period was 59.1 ± 34.5 (range: 2–134) months. Residual lesions or local or distant recurrence were not observed. Conclusions OP is a rare disease, and the exact aetiology remains unclear. Preoperative diagnosis is difficult to achieve despite the use of transbronchial biopsy or CT-guided percutaneous needle aspiration. Complete surgical resection represents an effective method for the treatment of OP.

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Tocilizumab for refractory organising pneumonia associated with Sjögren's disease

Cited by 36 publications

References 18 publications

The Two-Faced Cytokine IL-6 in Host Defense and Diseases

The Two-Faced Cytokine IL-6 in Host Defense and Diseases

Pulmonary manifestations of Sjögren's syndrome

Surgical management of organizing pneumonia: a retrospective study of 24 cases in a single Centre

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