The risk of interstitial lung disease during biological treatment in Japanese patients with psoriasis

Abstract

Summary Background With the increasing use of biological agents for the treatment of psoriasis, the numbers of patients with interstitial lung disease (ILD) associated with biologics have also increased. Many of these cases were associated with tumour necrosis factor (TNF)‐α inhibitors, but cases associated with other families of biologics have also been reported in Japan. Aim To analyse the background factors of patients who developed ILD, and to discuss better management of biological treatment. Method We reviewed 246 patients with psoriasis who were treated with biological agents in our department to identify any pulmonary adverse events (AEs). Data on patients who developed ILD were extracted to analyse background factors, clinical type of psoriasis, time to onset of ILD, pre‐existing ILD, smoking habit and prescribed drugs. Results Pulmonary AEs were seen in 22 cases, of which 11 were diagnosed as drug‐induced ILD. The causative drugs were mainly TNF‐α inhibitors, accounting for eight cases (six treated with infliximab, two with adalimumab). The remaining three cases were associated with secukinumab, ustekinumab and ixekizumab (n = 1 each). Notably, these three cases also had a history of drug‐induced ILD. Conclusion Patients with a history of drug‐induced ILD seem to be more susceptible to developing another ILD induced by biologics, even if treated with interleukin‐17 inhibitors. Thorough screening of risk factors and evaluation for eligibility, and careful monitoring during treatment are the best solutions to avoid serious pulmonary AE. Early detection and precise diagnosis of pulmonary AEs, especially differentiation from infectious diseases, is essential for managing biological treatment.

Clinical characteristics and health‐care resource utilization in patients with generalized pustular psoriasis using real‐world evidence from the Japanese Medical Data Center database

“…Another prevalent respiratory comorbidity was interstitial pneumonia. Interstitial lung disease has previously been associated with biologic use in patients with different types of psoriasis in Japan 22 . The use of biologics may therefore contribute to the increased prevalence of interstitial pneumonia in patients with GPP in Japan; however, this association is not clear from this database.…”

Biologics in Psoriasis: Updated Perspectives on Long-Term Safety and Risk Management

“… 98 Another series identified eight cases on anti-TNF agents, and one case each on secukinumab, ixekizumab and ustekinumab. 100 A retrospective cohort study published in 2015 found no difference in risk of interstitial lung disease in rheumatoid arthritis patients treated with anti-TNFs versus those receiving abatacept, rituximab or tocilizumab. 101 Given the lack of data, it is not possible to conclude whether biologics used in patients with psoriasis are truly associated with an increased risk of interstitial lung disease.…”

“…Interstitial lung disease has also recently been reported as a potential adverse event to all biologic classes used in psoriasis. 99 , 100 One retrospective review of 603 psoriasis patients on anti-IL17/23 biologics identified six cases of interstitial lung disease occurring at a mean of 14 months after biologic initiation, with five improving after drug cessation. 98 Another series identified eight cases on anti-TNF agents, and one case each on secukinumab, ixekizumab and ustekinumab.…”

Patient characteristics and burden of disease in Japanese patients with generalized pustular psoriasis: Results from the Medical Data Vision claims database

“…psoriatic arthritis, osteoporosis), 17 as well as those associated with biologic use in patients with psoriasis (e.g. interstitial pneumonia) 18 . This suggests that patients with GPP experience a higher burden of illness than those with plaque psoriasis.…”

“…18-64 years to receive systemic steroids (35.7% vs. 31.3%).TA B L E 2Note: All medication groups are mutually exclusive. Abbreviation: GPP, generalized pustular psoriasis.F I G U R E 4 Dermatologic medication use during the 12-month follow-up period on or after the qualifying claim date.…”