A fatal case of acute exacerbation of interstitial lung disease in a patient with rheumatoid arthritis during treatment with tocilizumab

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• 作者：Shin-ya Kawashiri (1)
  Atsushi Kawakami (1)
  Noriho Sakamoto (2)
  Yuji Ishimatsu (2)
  Katsumi Eguchi (1)
  
• 关键词：Tocilizumab ; Rheumatoid arthritis ; Interstitial lung disease ; Pneumocystis pneumonia
• 刊名：Rheumatology International
• 出版年：2012
• 出版时间：December 2012
• 年：2012
• 卷：32
• 期：12
• 页码：4023-4026
• 全文大小：345KB
• 参考文献：1. Mihara M, Kasutani K, Okazaki M, Nakamura A, Kawai S, Sugimoto M et al (2005) Tocilizumab inhibits signal transduction mediated by both mIL-6R and sIL-6R, but not by the receptors of other members of IL-6 cytokine family. Int Immunopharmacol 5:1731-740 CrossRef
  2. Nishimoto N, Hashimoto J, Miyasaka N, Yamamoto K, Kawai S, Takeuchi T et al (2007) Study of active controlled monotherapy used for rheumatoid arthritis, an IL-6 inhibitor (SAMURAI): evidence of clinical and radiographic benefit from an x ray reader-blinded randomised controlled trial of tocilizumab. Ann Rheum Dis 66:1162-167 CrossRef
  3. Nishimoto N, Miyasaka N, Yamamoto K, Kawai S, Takeuchi T, Azuma J et al (2009) Study of active controlled tocilizumab monotherapy for rheumatoid arthritis patients with an inadequate response to methotrexate (SATORI): significant reduction in disease activity and serum vascular endothelial growth factor by IL-6 receptor inhibition therapy. Mod Rheumatol 19:12-9 CrossRef
  4. Smolen JS, Beaulieu A, Rubbert-Roth A, Ramos-Remus C, Rovensky J, Alecock E et al (2008) TOPTION Investigators. Effect of interleukin-6 receptor inhibition with tocilizumab in patients with rheumatoid arthritis (OPTION study): a double-blind, placebo-controlled, randomised trial. Lancet 371:987-97 CrossRef
  5. Genovese MC, McKay JD, Nasonov EL, Mysler EF, da Silva NA, Alecock E et al (2008) Interleukin-6 receptor inhibition with tocilizumab reduces disease activity in rheumatoid arthritis with inadequate response to disease-modifying antirheumatic drugs: the tocilizumab in combination with traditional disease-modifying antirheumatic drug therapy study. Arthritis Rheum 58:2968-980 CrossRef
  6. Jones G, Sebba A, Gu J, Lowenstein MB, Calvo A, Gomez-Reino JJ, Siri DA et al (2010) Comparison of tocilizumab monotherapy versus methotrexate monotherapy in patients with moderate to severe rheumatoid arthritis: The AMBITION study. Ann Rheum Dis 69:88-6 CrossRef
  7. Emery P, Keystone E, Tony HP, Cantagrel A, van Vollenhoven R, Sanchez A et al (2008) IL-6 receptor inhibition with tocilizumab improves treatment outcomes in patients with rheumatoid arthritis refractory to anti-tumour necrosis factor biologicals: results from a 24-week multicentre randomised placebo-controlled trial. Ann Rheum Dis 67:1516-523 CrossRef
  8. Hagiwara K, Sato T, Takagi-Kobayashi S, Hasegawa S, Shigihara N, Akiyama O (2007) Acute exacerbation of preexisting interstitial lung disease after administration of etanercept for rheumatoid arthritis. J Rheumatol 34:1151-154
  9. Chatterjee S (2004) Severe interstitial pneumonitis associated with infliximab therapy. Scand J Rheumatol 33:276-77 CrossRef
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  11. Takeuchi T, Tatsuki Y, Nogami Y, Ishiguro N, Tanaka Y, Yamanaka H et al (2008) Postmarketing surveillance of the safety profile of infliximab in 5000 Japanese patients with rheumatoid arthritis. Ann Rheum Dis 67:189-94 CrossRef
  12. Harigai M, Koike R, Miyasaka N (2007) Pneumocystis Pneumonia under Anti-Tumor Necrosis Factor Therapy (PAT) Study Group. Pneumocystis pneumonia associated with infliximab in Japan. N Engl J Med 357:1874-876 CrossRef
  13. Komano Y, Harigai M, Koike R, Sugiyama H, Ogawa J, Saito K et al (2009) Pneumocystis jiroveci pneumonia in patients with rheumatoid arthritis treated with infliximab: a retrospective review and case-control study of 21 patients. Arthritis Rheum 61:305-12 CrossRef
  14. Wolfe F, Caplan L, Michaud K (2006) Treatment for rheumatoid arthritis and the risk of hospitalization for pneumonia: associations with prednisone, disease-modifying antirheumatic drugs, and anti-tumor necrosis factor therapy. Arthritis Rheum 54:628-34 CrossRef
  
• 作者单位：Shin-ya Kawashiri (1)
  Atsushi Kawakami (1)
  Noriho Sakamoto (2)
  Yuji Ishimatsu (2)
  Katsumi Eguchi (1)
  
  1. Unit of Translational Medicine, Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
  2. Second Department of Internal Medicine, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
  

文摘

A 68-year-old man, who was a patient with established rheumatoid arthritis (RA) with RA-associated interstitial lung disease (RA-ILD) and pulmonary emphysema, began taking tocilizumab. Subsequently, he developed dyspnea parallel to improvement of RA. At 10?months after the administration of tocilizumab, he was urgently admitted because of exacerbation of ILD. He died despite receiving steroid pulse therapy and antibiotic therapy on a respirator. This is the first case report to describe the exacerbation of ILD during treatment with tocilizumab in the postmarketing surveillance (PMS) period.