Drug-induced interstitial lung disease

Jessurun, Naomi T; Drent, Marjolein; Puijenbroek, Eugène van; Bekers, Otto; Wijnen, Petal A.; Bast, Aalt

doi:10.1097/mcp.0000000000000590

Cited by 11 publications

(13 citation statements)

References 51 publications

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“…However, early recognition and management of DI morbidity is a real clinical challenge. There is a need for a tailored approach that can be adopted in clinical practice, based on disease severity and risk profiles [57]. Trials should be developed to investigate the role of genetic variations not only in disease susceptibility and prognosis, but also in treatment response, and in tailoring drug treatment to individual patients.…”

Section: Discussionmentioning

confidence: 99%

“…PGx may lead to a more accurate drug management regime aimed at preventing unnecessary ADRs, as well as increasing the efficacy of the drug, and improving QoL [57]. There is a need to develop trials investigating the role of genetic variations not only in disease susceptibility and predicting prognosis, but also in treatment response, and in tailoring drug treatment to individual patients.…”

Section: Future Directionsmentioning

confidence: 99%

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Drug-induced comorbidities in patients with sarcoidosis

Drent

Jessurun

Wijnen

et al. 2022

Current Opinion in Pulmonary Medicine

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Purpose of reviewSarcoidosis is a chronic multisystemic inflammatory disease of unknown aetiology with a wide range of highly variable clinical manifestations and unpredictable disease course. Sarcoidosis patients may present with specific organ-related symptoms involving functional impairments, and less specific symptoms. The decision whether and when to treat a sarcoidosis patient with pharmacotherapy depends on two major factors: risk of organ failure and/or death and impairment of quality of life. This decision is complex and not standardized.Recent findingsGlucocorticoids (GCs) are recommended as initial treatment, when needed. Subsequent GC-sparing alternatives frequently follow. Comorbidities or adverse drug reactions (ADRs) from drugs used in sarcoidosis treatment are sometimes very hard to differentiate from symptoms associated with the disease itself, which may cause diagnostic dilemmas. An ideal approach to minimalize ADRs would involve genetic screening prior to prescribing certain ‘high-risk drugs’ and therapeutic drug monitoring during treatment. Pharmacogenomic testing aims to guide appropriate selection of medicines, with the potential of reducing unnecessary polypharmacy while improving clinical outcomes.SummaryA multidisciplinary approach to the management of sarcoidosis may avoid unnecessary ADRs. It is important to consider the possibility of drug-induced damage in sarcoidosis, especially if the clinical situation deteriorates after the introduction of a particular drug.

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Section: Discussionmentioning

confidence: 99%

Section: Future Directionsmentioning

confidence: 99%

Drug-induced comorbidities in patients with sarcoidosis

Drent

Jessurun

Wijnen

et al. 2022

Current Opinion in Pulmonary Medicine

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“…The CYP2D6 and CYP3A enzymes involved are abundantly expressed in the human liver and lung. Additionally, just as in the liver, the pathogenesis of drug-associated cell injury in the lung may involve immune and cytotoxic mechanisms of action in which pharmacogenetics, reactive oxygen species, and reactive drug metabolites may play a role [10,11].…”

Section: Discussionmentioning

confidence: 99%

Tamsulosin Associated with Interstitial Lung Damage in CYP2D6 Variant Alleles Carriers

Jessurun

Wijnen

Bast

et al. 2020

IJMS

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Drugs are serious but underestimated causative agents of interstitial lung disease (ILD). Both cytotoxic and immune mechanisms may be involved in drug-induced ILD (DI-ILD). We aimed to investigate whether polymorphisms of relevant CYP enzymes involved in the metabolization of tamsulosin might explain the pathologic mechanism of the DI-ILD in the cases with suspected tamsulosin DI-ILD. We collected 22 tamsulosin-associated DI-ILD cases at two ILD Expertise Centers in the Netherlands between 2009 and 2020. CYP2D6, CYP2C9, CYP2C19, CYP3A4, and CYP3A5 single nucleotide polymorphisms were genotyped and compared with a control group of 78 healthy Caucasian male volunteers. Nine cases were phenotyped as CYP2D6 poor metabolizers and 13 as CYP2D6 intermediate metabolizers. The phenotypes of the cases differed significantly from those of the healthy controls, with more poor metabolizers. After withdrawal of tamsulosin, the pulmonary condition of three cases had improved, six patients had stabilized, and one patient stabilized after reducing the tamsulosin dose. The described 22 cases suggest that an association between the presence of CYP2D6 allelic variants and tamsulosin-associated ILD is highly likely. These cases highlight the importance of both clinical and genetic risk stratification aimed to achieve a more accurate prevention of DI-ILD in the future and enhance the quality of life of patients.

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“…GSSG is reduced to GSH by glutathione reductase which acquires its reducing equivalents via the pentose phosphate pathway. In this pathway glucose-6-phosphate dehydrogenase (G6PD) plays a decisive role [25]. It can thus be understood that G6PD should be intact to protect against the reactive oxygen species that arise like in the process of redox cycling.…”

Section: Mechanism Of Toxicitymentioning

confidence: 99%

“…It can thus be understood that G6PD should be intact to protect against the reactive oxygen species that arise like in the process of redox cycling. Several redox cycling drugs are to be avoided by people with a G6PD deficiency [25]. An illustrative example in this respect is nitrofurantoin which is used to treat urine tract infection or primaquine used in the malaria.…”

Section: Mechanism Of Toxicitymentioning

confidence: 99%

Pulmonary toxicity associated with occupational and environmental exposure to pesticides and herbicides

Bast

Semen

Drent

2021

Current Opinion in Pulmonary Medicine

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Purpose of review Critical review on the notion that exposure to pesticides and herbicides lead to adverse effects in pulmonary health. Recent findings The lung effects of several chemical classes of pesticides and herbicides is biologically plausible. However, the studies that describe the association between exposure and toxic lung effects have numerous limitations. Critical evaluation of the studies that are performed shows that assessment of occupational or environmental exposure to pesticides and herbicides is cumbersome. Moreover, the health effects are not always clearly established due to the use of questionnaires and self-reported data instead of lung function measurements or diagnostic work-up by physicians. Future studies should preferably better characterize the exposure. Genetic phenotyping should be included to understand and strengthen possible (individual) associations between exposure and health outcome. It should be realized that combined exposure to multiple environmental chemicals may lead to different health effects than exposure to individual chemicals. Summary The relation between exposure to pesticides and herbicides and lung toxicity is less clear than generally assumed. Adverse lung effects seem multifactorial and needs further research. Preventive measures remain key.

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Drug-induced interstitial lung disease

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Cited by 11 publications

References 51 publications

Drug-induced comorbidities in patients with sarcoidosis

Drug-induced comorbidities in patients with sarcoidosis

Tamsulosin Associated with Interstitial Lung Damage in CYP2D6 Variant Alleles Carriers

Pulmonary toxicity associated with occupational and environmental exposure to pesticides and herbicides

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