Biologic agentInterstitial Lung Disease Induced or Exacerbated by TNF-Targeted Therapies: Analysis of 122 Cases
Section snippets
Methods
In 2006, the Study Group on Autoimmune Diseases (GEAS) of the Spanish Society of Internal Medicine created the BIOGEAS project (www.biogeas.org), a multicenter study dedicated to collecting data on the use of biologic agents in adult patients with systemic autoimmune diseases (8). An additional objective of the BIOGEAS project is to collect data on autoimmune diseases secondary to the use of biologic agents by a quarterly surveillance of reported cases by a Medline search (7).
Case Report
First, we report an unpublished case of ILD secondary to biologic therapies. A 40-year-old woman had a 4-year history of psoriatic arthritis that was initially treated with low-dose steroids and methotrexate (up to 20 mg/wk). In December 2008, due to extensive cutaneous involvement and an arthritis flare, methotrexate was stopped and adalimumab 40 mg fortnightly was started. A tuberculin test was negative and a baseline chest radiograph showed no pulmonary abnormalities. Due to persistence of
Results
Figure 2 shows a flow diagram of the search results. The search strategy yielded 35 case reports (10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44), 2 postmarketing studies (45, 46), and 2 retrospective studies (47, 48). In total, there were 122 reported cases (including the abovementioned new case) of new-onset or exacerbation of ILD secondary to the administration of biologic therapies (Table 1). Some
Discussion
The development of ILD in patients with rheumatic and autoimmune diseases treated with biologic therapies has been increasingly reported since the first case in 2002 (44). However, there are no specific studies on the clinical presentation of ILD observed during therapy with biologic agents, and a global analysis of the 122 reported cases may help define the main clinical characteristics. We found that 97% of cases were associated with agents blocking TNF. The clinical profile of a patient with
Acknowledgment
The authors wish to thank David Buss for his editorial assistance.
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