Efficacy and Safety of Rituximab in Autoimmune Disease—Associated Interstitial Lung Disease: A Prospective Cohort Study

Abstract

Objectives: To analyze the efficacy and safety of rituximab (RTX) in connective tissue disease associated with interstitial lung disease (CTD-ILD). Methods: We performed a multicenter, prospective, observational study of patients with CTD-ILD receiving rituximab between 2015 and 2020. The patients were assessed using high-resolution computed tomography and pulmonary function tests at baseline, at 12 months, and at the end of follow-up. The main outcome measure at the end of follow-up was forced vital capacity (FVC) > 10% or diffusing capacity of the lungs for carbon monoxide (DLCO) > 15% and radiological progression or death. We recorded clinical characteristics, time to initiation of RTX, concomitant treatment, infections, and hospitalization. A Cox regression analysis was performed to identify factors associated with worsening ILD. Results: We included 37 patients with CTD-ILD treated with RTX for a median (IQR) of 38.2 (17.7–69.0) months. At the end of the follow-up, disease had improved or stabilized in 23 patients (62.1%) and worsened in seven (18.9%); seven patients (18.9%) died. No significant decline was observed in median FVC (72.2 vs. 70.8; p = 0.530) or DLCO (55.9 vs. 52.2; p = 0.100). The multivariate analysis showed the independent predictors for worsening of CTD-ILD to be baseline DLCO (OR (95% CI), 0.904 (0.8–0.9); p = 0.015), time to initiation of RTX (1.01 (1.001–1.02); p = 0.029), and mycophenolate (0.202 (0.04–0.8); p = 0.034). Only 28 of the 37 patients (75.6%) were still undergoing treatment with RTX: two patients (5.4%) stopped treatment due to adverse events and seven patients (18.9%) died owing to progression of ILD and superinfection. Conclusion: Lung function improved or stabilized in more than half of patients with CTD-ILD treated with RTX. Early treatment and combination with mycophenolate could reduce the risk of progression of ILD.

Novel Biomarkers, Diagnostic and Therapeutic Approach in Rheumatoid Arthritis Interstitial Lung Disease—A Narrative Review

“…Rituximab, tocilizumab, and abatacept have all been shown to have favorable results in recent studies, with the disease in treated individuals maintaining constant or improving as measured by PFTs. However, most of these investigations are small, uncontrolled retrospective studies, and their findings must be confirmed in RCTs [ 99 , 100 , 101 ].…”

Treating Autoimmune-Related Interstitial Lung Disease With B Cell Depletion

“…Mena-Vazquez et al evaluated 37 patients with CTD-ILD that received RTX as add-on therapy upon the deterioration of either clinical symptoms or PFTs compared to the time of diagnosis ( 14 ). Nineteen patients with RA (51.4%), 14 with SS (37.8%), and 4 with IM (10.8%) received RTX in the “RA scheme” and were evaluated before and 12 months after treatment.…”

Nuevos biomarcadores y enfoques diagnósticos y terapéuticos en la enfermedad pulmonar intersticial por artritis reumatoide: una revisión narrativa

“…El rituximab, el tocilizumab y el abatacept han mostrado resultados favorables en estudios recientes, en los que la enfermedad en los individuos tratados se ha mantenido constante o ha mejorado, según resultados de las PFTs. Sin embargo, la mayoría de estas investigaciones son estudios pequeños de tipo retrospectivo, no controlados, y sus resultados deben confirmarse en RCT [99, 100, 101].…”