Addition of antifibrotic therapy to immunosuppression in hypersensitivity pneumonitis: A case series.
Addition of antifibrotic therapy to immunosuppression in hypersensitivity pneumonitis: A case series.
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DOI：
10.1016/j.rmcr.2021.101562
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发表时间：
2021
影响因子：
1.1
通讯作者：
Adams TN
中科院分区：
文献类型：
--
作者：
Kypreos M;Barbera T;Newton CA;Glazer CS;Adams TN
过敏性肺炎历来采用免疫抑制治疗，但最近尼达尼布获批用于治疗进行性纤维化HP。INBUILD的一个局限性是，入组时唯一允许的免疫抑制（IS）是糖皮质激素，剂量低于20 mg/天，因此抗纤维化（AF）治疗对HP IS的累加效应尚不清楚。我们介绍了5例HP患者，他们在IS基础上加用AF治疗。在队列中观察到的趋势包括5例患者中有4例在IS基础上增加AF后一年内FVC、需氧量和症状下降减少。根据INBUILD试验中概述的标准，我们系列中的所有5例患者（100%）在开始抗纤维化治疗前一年均显示进展，但5例患者中只有1例（20%）在AF后一年内进展。与抗纤维化治疗前12个月相比，开始抗纤维化治疗后12个月内FVC %预测值的相对下降率显著降低（0.4% ±7.6 vs −17.5% ±7.6，p = 0.0495）。与抗纤维化治疗前12个月相比，开始抗纤维化治疗后12个月内符合进展标准的患者较少（p = 0.048）。同样，与开始抗纤维化治疗前6个月相比，在开始抗纤维化治疗后6个月内符合进展标准的患者较少（p = 0.048）。需要对单独IS和单独AF的对照组进行更大规模的研究，以确认AF治疗联合IS在HP患者中的作用。
Hypersensitivity pneumonitis has historically been treated with immunosuppression, but recently nintedanib was approved for the treatment of progressive fibrotic HP. One limitation of INBUILD is that the only immunosuppression (IS) permitted at the time of enrollment was glucocorticoids at a dose of less than 20mg per day, so the additive effect of antifibrotic (AF) therapy to IS in HP remains unclear. We present 5 cases of patients with HP for whom AF therapy was added to IS. Trends observed in the cohort include reduced decline in FVC, oxygen requirement, and symptoms in the year after adding AF to IS in 4 of the 5 patients. All 5 patients (100%) in our series demonstrated progression in the year prior to initiation of antifibrotic based on criteria outlined in the INBUILD trial, but only 1 of 5 (20%) progressed in the year after AF. There was a significant decrease in the rate of relative decline in % predicted FVC in the 12 months after initiation of antifibrotic compared to the 12 months prior to antifibrotic (0.4% ±7.6 vs −17.5% ±7.6, p = 0.0495). Compared to the 12 months prior to antifibrotic therapy, fewer patients met criteria for progression in the 12 months after initiating antifibrotic therapy (p = 0.048). Similarly, fewer patients met criteria for progression in the 6 months after initiating antifibrotic therapy compared to the 6 months prior (p = 0.048). A larger study with control groups on IS alone and AF alone is needed to confirm the role of AF therapy in combination with IS in patients with HP.
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