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Rheumatology (Oxford). 2016 Jul;55(7):1318-24. doi: 10.1093/rheumatology/kew195. Epub 2016 Apr 8.

Rituximab in autoimmune connective tissue disease-associated interstitial lung disease.

Author information

1
Southmead Hospital, Academic Respiratory Unit, University of Bristol, Bristol.
2
Department of Geography, London School of Economics, Houghton Street, London.
3
Bristol Interstitial Lung Disease Service.
4
Bristol Interstitial Lung Disease Service Academic Rheumatology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK harsha.gunawardena@nbt.nhs.uk.

Abstract

OBJECTIVE:

CTD-associated interstitial lung disease (ILD) often fails to respond to conventional immunomodulatory agents. There is now considerable interest in the use of rituximab in systemic autoimmune CTD in patients refractory to standard treatments. The aim of this study was to review the experience of North Bristol NHS Trust managing patients with CTD-associated ILD with rituximab and explore possible associations with treatment response.

METHODS:

We conducted a retrospective analysis of all patients who received rituximab under the Bristol CTD-ILD service, having failed to respond to other immunomodulatory treatments. Results were collated for pulmonary function and radiological outcomes before and after treatment.

RESULTS:

Twenty-four patients were treated with rituximab. Their physiological parameters had failed to improve despite other immunomodulatory agents, with a mean change in forced vital capacity (FVC) prior to therapy of - 3.3% (95% CI - 5.6, -1.1) and mean change in diffusing capacity of carbon monoxide of - 4.3% (95% CI - 7.7, -0.9). After rituximab, radiology remained stable or improved for 11 patients, while worsening was observed in 9 patients. The decline in FVC was halted following treatment, with a mean change of + 4.1% (95% CI 0.9, 7.2), while diffusing capacity of carbon monoxide was stable [mean change +2.1% (95% CI - 1.0, 5.2)]. Patients with myositis overlap or antisynthetase syndrome appeared to respond well to treatment, with four patients showing clinically significant improvement in FVC >10%.

CONCLUSION:

Rituximab is a therapeutic option in treatment-refractory CTD-associated ILD. Some disease subgroups may respond better than others, however, more work is needed to define its role in managing these patients.

KEYWORDS:

connective tissue disease; interstitial lung disease; rituximab; treatment

PMID:
27060110
DOI:
10.1093/rheumatology/kew195
[Indexed for MEDLINE]

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