Pulmonary Disorders Induced by Monoclonal Antibodies in Patients with Rheumatologic Autoimmune Diseases

详细信息    查看全文

• 作者：Manuel Ramos-Casals MD ; PhD^a ; Roberto Perez-Alvarez MD ; PhD^b ; Marta Perez-de-lis MD ; PhD^b ; Antoni Xaubet MD ; PhD^c ; Xavier Bosch MD ; PhD^d ; ^{xavbosch@clinic.ub.es"" rel=""nofollow} ; BIOGEAS Study Group
• 关键词：Pulmonary disorders ; Rheumatoid arthritis ; Sarcoidosis ; Tumor necrosis factor
• 刊名：The American Journal of Medicine
• 出版年：2011
• 出版时间：May 2011
• 年：2011
• 卷：124
• 期：5
• 页码：386-394
• 全文大小：1072 K

文摘

Monoclonal antibodies have emerged as a new class of agents causing drug-related pulmonary involvement in patients with systemic rheumatologic autoimmune diseases. The most frequently associated noninfectious pulmonary diseases are interstitial pneumonia (118 cases reported by August 2010), sarcoid-like disease and vasculitis (40 cases), and 97 % of cases are associated with agents blocking tumor necrosis factor (TNF), a cytokine implicated in pulmonary fibrosis, granuloma formation, and maintenance. Drug-induced interstitial pneumonia has a poor prognosis, with an overall mortality rate of around one-third, rising to two-thirds in patients with pre-existing interstitial disease. Sarcoid-like disease has a better prognosis, with resolution or improvement in 90 % of cases. Although the evidence comes overwhelmingly from case reports and case series, suggested recommendations for patient management include a detailed pre-therapeutic evaluation, early identification of symptoms suggestive of pulmonary disease, and tailored therapy. Mycobacterial infection should be exhaustively investigated, especially after anti-TNF administration. Large, prospective, postmarketing studies including nonbiological agents as controls may help elucidate the real risk of pulmonary disease in patients with rheumatologic autoimmune diseases receiving monoclonal antibodies.