How consistently do physicians diagnose and manage drug-induced interstitial lung disease? Two surveys of European ILD specialist physicians

Abstract

IntroductionCurrently there are no general guidelines for diagnosis or management of suspected drug-induced (DI) interstitial lung disease (ILD). The objective was to survey a sample of current European practice in the diagnosis and management of DI-ILD, in the context of the prescribing information approved by regulatory authorities for 28 licenced drugs with a recognised risk of DI-ILD.MethodsConsultant physicians working in specialist ILD centres across Europe were emailed two surveys via a website link. Initially, opinion was sought regarding various diagnostic and management options based on seven clinical ILD case vignettes and five general questions regarding DI-ILD. The second survey involved 29 statements regarding the diagnosis and management of DI-ILD, derived from the results of the first survey. Consensus agreement was defined as 75% or greater.ResultsWhen making a diagnosis of DI-ILD, the favoured investigations used (other than computed tomography) included pulmonary function tests, bronchoscopy and blood tests. The preferred method used to decide when to stop treatment was a pulmonary function test. In the second survey, the majority of the statements were accepted by the 33 respondents, with only four of 29 statements not achieving consensus when the responses “agree” and “strongly agree” were combined as one answer.ConclusionThe two surveys provide guidance for clinicians regarding an approach to the diagnosis and management of DI-ILD in which the current evidence base is severely lacking, as demonstrated by the limited information provided by the manufacturers of the drugs associated with a high risk of DI-ILD that we reviewed.

Chest CT Diagnosis and Clinical Management of Drug-related Pneumonitis in Patients Receiving Molecular Targeting Agents and Immune Checkpoint Inhibitors: A Position Paper from the Fleischner Society

“…In addition, improvement may merely be coincidental and due to a self-limited event (eg, aspiration pneumonia) with spontaneous recovery. Nonetheless, glucocorticoid therapy is commonly used in the management of patients suspected of having DRP, especially if the lung injury is severe or progressive, and response to glucocorticoid therapy would support a diagnosis of DRP (vs progression of underlying cancer, for example) in the absence of a better alternative explanation (27,45,48,49). Improvement with glucocorticoid therapy may also obviate invasive diagnostic maneuvers such as bronchoscopic or surgical lung biopsy.…”

Emerging technologies and their impact on regulatory science

“…151 It is serious enough to be included in the prescribing information, and in three cases, as a boxed warning. 152 It can involve immuno-oncology drugs as well as anti-infectives and older cancer drugs, anti-inflammatories, and so on. While chest radiography is sometimes advised in the prescribing information 152 there is little use of modern imaging modalities or of cut-offs or decision trees.…”

“…152 It can involve immuno-oncology drugs as well as anti-infectives and older cancer drugs, anti-inflammatories, and so on. While chest radiography is sometimes advised in the prescribing information 152 there is little use of modern imaging modalities or of cut-offs or decision trees. TRISTAN employs modern modalities; CT, 129Xe MRI, proton MRI (including oxygen-enhanced and gadolinium-enhanced), and some PET biomarkers.…”