Browsing by Subject "interstitial lung disease"

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    Knowledge Gaps and Research Priorities in Immune Checkpoint Inhibitor–related Pneumonitis. An Official American Thoracic Society Research Statement
    (American Thoracic Society - AJRCCM, 2019-09-15) Sears, Catherine R.; Peikert, Tobias; Possick, Jennifer D.; Naidoo, Jarushka; Nishino, Mizuki; Patel, Sandip P.; Camus, Philippe; Gaga, Mina; Garon, Edward B.; Gould, Michael K.; Limper, Andrew H.; Montgrain, Philippe R.; Travis, William D.; Rivera, M. Patricia; Medicine, School of Medicine
    Rationale: Immune checkpoint inhibitors (ICIs) have revolutionized cancer care but are associated with unique adverse events, including potentially life-threatening pneumonitis. The diagnosis of ICI-pneumonitis is increasing; however, the biological mechanisms, clinical and radiologic features, and the diagnosis and management have not been well defined. Objectives: To summarize evidence, identify knowledge and research gaps, and prioritize topics and propose methods for future research on ICI-pneumonitis. Methods: A multidisciplinary group of international clinical researchers reviewed available data on ICI-pneumonitis to develop and refine research questions pertaining to ICI-pneumonitis. Results: This statement identifies gaps in knowledge and develops potential research questions to further expand knowledge regarding risk, biologic mechanisms, clinical and radiologic presentation, and management of ICI-pneumonitis. Conclusions: Gaps in knowledge of the basic biological mechanisms of ICI-pneumonitis, coupled with a precipitous increase in the use of ICIs alone or combined with other therapies, highlight the importance in triaging research priorities for ICI-pneumonitis.
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    Treatment outcomes for rheumatoid arthritis associated interstitial lung disease; a real-world, multisite study of the impact of immunosuppression on pulmonary function trajectory
    (Elsevier, 2023-04) Matson, Scott M.; Baqir, Misbah; Moua, Teng; Marll, Michael; Kent, Jessica; Iannazzo, Nicholas S.; Boente, Ryan D.; Donatelli, John M.; Dai, Junqiang; Diaz, Francisco J.; Demoruelle, M. Kristen; Hamblin, Mark B.; Mathai, Susan K.; Ryu, Jay H.; Pope, Kristen; Walker, Christopher M.; Lee, Joyce S.; Medicine, School of Medicine
    Background Rheumatoid arthritis (RA) associated interstitial lung disease (ILD) is common in patients with RA and leads to significant morbidity and mortality. There are no randomized, placebo-controlled data to support the role of immunosuppression to treat RA-ILD despite being widely used in clinical practice. Research Question How does immunosuppression impact pulmonary function trajectory in a multi-site retrospective cohort of RA-ILD patients? Study Design and Methods Patients with RA who started treatment for ILD with mycophenolate, azathioprine, or rituximab were retrospectively identified from five ILD centers. Change in lung function before and after treatment was analyzed using a linear spline mixed effect model with random intercept. Prespecified secondary analyses examined the impact of radiologic pattern of ILD (i.e., usual interstitial pneumonia [UIP] vs non-UIP) on treatment trajectory. Results 212 patients were included in the analysis: 92 (43.4%) were treated with azathioprine, 77 (36.3%) with mycophenolate mofetil and 43 (20.3%) with rituximab. In the combined analysis of all three agents, there was an improvement in forced vital capacity (FVC) % predicted after 12 months of treatment compared to the potential 12-month response without treatment [+3.90%, p=< 0.001; 95% CI, (1.95, 5.84)]. Diffusing capacity for carbon monoxide (DLCO) % predicted also improved at 12 months [+4.53%, p=<0.001; (2.12, 6.94)]. Neither the UIP pattern of ILD or choice of immunosuppressive agent significantly impacted the pulmonary function trajectory on immunosuppression. Interpretation Immunosuppression was associated with an improved trajectory in FVC and DLCO compared to the pre-treatment pulmonary function trajectory. Prospective, randomized trials are required to validate these findings.