Format

Send to

Choose Destination
Chest. 2017 Mar;151(3):619-625. doi: 10.1016/j.chest.2016.10.029. Epub 2016 Nov 3.

Use of Mycophenolate Mofetil or Azathioprine for the Management of Chronic Hypersensitivity Pneumonitis.

Author information

1
Department of Medicine, University of California, San Francisco, San Francisco, CA; Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada. Electronic address: julie.morisset@umontreal.ca.
2
Department of Medicine, University of Calgary, Calgary, AB, Canada.
3
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
4
Department of Respiratory Diseases, Pontifical Catholic University of Chile, Santiago, Chile.
5
Department of Radiology, University of California, San Francisco, San Francisco, CA.
6
Department of Pathology, University of California, San Francisco, San Francisco, CA.
7
Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
8
Department of Medicine, University of California, San Francisco, San Francisco, CA.
9
Department of Medicine and Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.

Abstract

BACKGROUND:

The treatment of chronic hypersensitivity pneumonitis (cHP) often includes systemic oral corticosteroids, but the optimal pharmacologic management remains unclear. The morbidity associated with prednisone has motivated the search for alternative therapies. We aimed to determine the effect of treatment with mycophenolate mofetil (MMF) or azathioprine (AZA) on lung function in patients with cHP.

METHODS:

Patients with cHP treated with either MMF or AZA were retrospectively identified from four interstitial lung disease centers. Change in lung function before and after treatment initiation was analyzed using linear mixed-effects modeling (LMM), adjusting for age, sex, smoking history, and prednisone use.

RESULTS:

Seventy patients were included: 51 were treated with MMF and 19 with AZA. Median follow-up after treatment initiation was 11 months. Prior to treatment initiation, FVC and diffusion capacity of the lung for carbon monoxide (Dlco) % predicted were declining at a mean rate of 0.12% (P < .001) and 0.10% (P < .001) per month, respectively. Treatment with either MMF or AZA was not associated with improved FVC (0.5% at 1 year; P = .46) but was associated with a statistically significant improvement in Dlco of 4.2% (P < .001) after 1 year of treatment. Results were similar in the subgroup of patients treated with MMF for 1 year; the FVC increased nonsignificantly by 1.3% (P = .103) and Dlco increased by 3.9% (P < .001).

CONCLUSIONS:

Treatment with MMF or AZA is associated with improvements in Dlco in patients with cHP. Prospective randomized trials are needed to validate their effectiveness for cHP.

KEYWORDS:

azathioprine; hypersensitivity pneumonitis; interstitial lung disease; mycophenolate mofetil

PMID:
27816444
PMCID:
PMC6026221
DOI:
10.1016/j.chest.2016.10.029
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center