风湿

利妥昔单抗对RA相关肺间质病变有效

作者:Md Yusof MY,et al. 翻译:北医三院翟佳羽 来源:中国风湿病公众论坛 日期:2017-05-18
导读

         利妥昔单抗对类风湿关节炎相关肺间质病变有效

关键字:  利妥昔单抗 

目的

        :评估利妥昔单抗(RTX)对类风湿关节炎相关间质性肺疾病(RA-ILD)的疗效并明确治疗后预后的相关因素。

方法:

        从一个单中心随访10年的RTX治疗类风湿关节炎的队列中,进行RA-ILD的观察性研究。进展定义为如下之一:相比RTX治疗前用力肺活量(FVC)下降>10%或一氧化碳弥散量(DLCO)下降>15%预测值,间质性肺疾病评分恶化或由于进展的间质性肺疾病而死亡。

结果:

        700例使用RTX治疗的类风湿关节炎患者中,56例有RA-ILD(发生率8%)。RTX治疗后,新发间质性肺疾病者共3例(发生率0.4%)。共44/56例患者有肺评估的数据。RTX治疗前后FVC平均相对变化分别为-2.4%和+1.2%(p=0.025),DLCO的平均相对变化分别为-4.4%和-1.3%(p=0.045)。RTX治疗后,23/44(52%)稳定,7/44(16%)有改善。14例(32%)患者间质性肺疾病进展,其中,9/56例(16%)由于进展性间质性肺疾病而死亡。间质性肺疾病进展的因素包括寻常型间质性肺炎、既往肺疾病进展史和RTX治疗前DLCO<46%预计值。11/14例(79%)间质性肺疾病进展的患者在RTX治疗前有严重间质性肺疾病(平均DLCO为42%预计值)。

结论:

        在这个RTX治疗关节炎的队列中,长期随访治疗后大部分患者间质性肺疾病保持稳定或有改善。有恶化/死亡的患者在RTX治疗前有严重间质性肺疾病,提示药物无效。RTX是RA-ILD患者可行的治疗选择且有待进一步的研究。

        END

        附原文:

OBJECTIVE

        : To evaluate the effect of rituximab (RTX) in patients with RA-related interstitial lung disease (RA-ILD) and identify factors associated with outcome after treatment.

METHODS

        : An observational study of patients with RA-ILD was conducted from a cohort of RTX-treated RA patients in a single centre for >10 years. Progression was defined by any of the following: a decrease of pre-RTX forced vital capacity (FVC) >10% or diffusion capacity of carbon monoxide (DLCO) >15% predicted, worsening of the ILD score or death from progressive ILD.

RESULTS:

        Of 700 RA patients treated with RTX, 56 had RA-ILD (prevalence = 8%). After RTX, new ILD was diagnosed in 3/700 patients (incidence = 0.4%). Data for lung assessment were available for 44/56 patients. The median relative change pre- and post-RTX for FVC were -2.4% and +1.2% ( P = 0.025) and for DLCO were -4.4% and -1.3% ( P = 0.045). Post-RTX, 23/44 (52%) were stable and 7/44 (16%) had improved. Of the 14 (32%) with ILD that progressed, 9/56 (16%) were deaths due to progressive ILD. Factors associated with ILD progression were radiologic pattern of usual interstitial pneumonia, a previous history of lung progression and pre-RTX DLCO <46% predicted. Of those whose ILD progressed, 11/14 (79%) had severe ILD before RTX [median DLCO 42% predicted (interquartile range 41-49)].

CONCLUSION

        : In this cohort of patients where RTX was given for arthritis, most patients with ILD pre-RTX remained stable/improved after treatment over a prolonged follow-up period. Patients who deteriorated/died had the most severe ILD pre-RTX, suggesting the drug was not contributory. RTX appears to be an acceptable therapeutic choice for patients with RA-ILD and further studies are warranted.

        引自:Md Yusof MY,Kabia A,Darby M,et al. Effect of rituximab on the progression of rheumatoid arthritis-related interstitial lung disease: 10 years' experience at a single centre.Rheumatology(Oxford).2017 Apr 24. doi: 10.1093/rheumatology/kex072. [Epub ahead of print]

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