Rituximab improves interstitial lung disease associated with antisynthetase syndrome
Treatment with rituximab (RTX) is well tolerated and leads to stability or improvement in pulmonary function or severity of interstitial lung disease (ILD) on computed tomography (CT) in most patients, a recent study has shown.
A total of 25 patients at the Brigham and Women’s Hospital (n=13) and University of Pittsburgh Medical Center (n=12) participated in the study. Antisynthetase antibodies (16 Jo1, six PL-12 and three PL-7) were identified in all patients. The main indication for RTX use in 21 patients (84 percent) was recurrent or progressive ILD due to the failure of other agents.
Comparisons between pre- and post-RTX pulmonary variables at 12 months showed stable or improved CT score and forced vital capacity in 88 percent and 79 percent of patients, respectively. Total lung capacity (%) increased from 56±13 to 64±13, and glucocorticoid dose decreased from 18±9 to 12±12 mg/day. Diffusing capacity of the lungs for carbon monoxide slightly decreased at 1 year, but it increased from 42±17 to 70±20 at 3 years.
Nonspecific interstitial pneumonia (NSIP; n=13) and usual interstitial pneumonia/fibrotic NSIP (n=5) were the most common imaging patterns on CT. Of these, five had concurrent elements of cryptogenic organizing pneumonia.
“RTX may play a therapeutic role in patients with antisynthetase syndrome (AS)-ILD, and further clinical investigation is warranted,” the authors said.
To evaluate clinical outcomes in patients with AS-ILD, the authors retrospectively identified all patients at two institutions who were treated with RTX and assessed baseline demographics, pulmonary function testing and chest CT pre- and post-RTX. Two radiologists independently evaluated CT using a standardized scoring system.