Safety of Tocilizumab on Rheumatoid Arthritis in Patients with Interstitial Lung Disease.

IF 1.7 Q3 RHEUMATOLOGY Open Access Rheumatology-Research and Reviews Pub Date : 2024-06-11 eCollection Date: 2024-01-01 DOI:10.2147/OARRR.S462662

Naotatsu Otsuji, Kumiya Sugiyama, Takayoshi Owada, Hajime Arifuku, Kenya Koyama, Hirokuni Hirata, Yasutsugu Fukushima

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Abstract

Purpose: The prognosis of rheumatoid arthritis (RA) with interstitial lung disease (ILD) is particularly poor. Although drugs that do not contribute to the progression of ILD should be used in RA treatment, none have been established. This study evaluated the safety of tocilizumab in terms of ILD activity.

Patients and methods: This study prospectively enrolled all 55 patients with RA complicated by ILD who were treated with tocilizumab at Dokkyo Medical University Saitama Medical Center from April 2014 to June 2022. The outcome measures were MMP-3 and KL-6 as biomarkers of RA and ILD activity, respectively, and the relationship between them was analyzed.

Results: Both MMP-3 and KL-6 were significantly improved at 6 months of treatment (P < 0.001 and P < 0.05, respectively), and a weak correlation between MMP-3 and KL-6 was observed (R² = 0.086, P = 0.087). The group with increased MMP-3 due to RA progression had significantly higher KL-6 at 6 months compared with the group with RA improvement (P < 0.05). Also, the group with ILD progression on computed tomography had significantly higher MMP-3 compared with the groups with improvement or no change of ILD (P < 0.05 and P < 0.01, respectively). The mortality rate was 0% at 6 months, 2.0% at 1 year, 16.7% at 2 years, and 32.4% at 3 years, and mortality from acute exacerbation of ILD due to respiratory infection increased over time.

Conclusion: RA activity and ILD activity were found to be related at 6 months of treatment. Tocilizumab does not seem to affect the mechanism of ILD progression, as most patients showed improvement in both MMP-3 and KL-6 with tocilizumab within 6 months, when this drug would be expected to affect the lungs directly. However, respiratory infection exacerbated ILD from 1 year after the start of treatment. As immunosuppressive drugs, including tocilizumab, have a risk of respiratory infection, it is important to identify early signs of infection.

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托西珠单抗对间质性肺病患者类风湿性关节炎的安全性

目的：类风湿性关节炎（RA）合并间质性肺病（ILD）的预后特别差。尽管在 RA 治疗中应使用不会导致 ILD 恶化的药物，但目前还没有确定的药物。本研究评估了托珠单抗在ILD活性方面的安全性：本研究前瞻性地纳入了2014年4月至2022年6月期间在独协医科大学埼玉医疗中心接受托西珠单抗治疗的所有55例并发ILD的RA患者。结果分别以MMP-3和KL-6作为RA和ILD活性的生物标志物，并分析了两者之间的关系：结果：治疗6个月后，MMP-3和KL-6均有明显改善（分别为P＜0.001和P＜0.05），且MMP-3和KL-6之间存在弱相关性（R2=0.086，P=0.087）。因RA进展导致MMP-3增加的一组与RA改善的一组相比，在6个月时KL-6明显升高（P＜0.05）。此外，与ILD改善或无变化组相比，计算机断层扫描显示ILD进展组的MMP-3明显升高（分别为P < 0.05和P < 0.01）。6个月时的死亡率为0%，1年时为2.0%，2年时为16.7%，3年时为32.4%：结论：治疗6个月后，发现RA活动度与ILD活动度相关。托西珠单抗似乎不会影响 ILD 的进展机制，因为大多数患者在使用托西珠单抗 6 个月后，MMP-3 和 KL-6 均有所改善，而这种药物本应直接影响肺部。然而，从治疗开始一年后，呼吸道感染加剧了 ILD。由于包括托西珠单抗在内的免疫抑制剂有呼吸道感染的风险，因此识别感染的早期迹象非常重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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