The risk of interstitial lung disease during biological treatment in Japanese patients with psoriasis
The risk of interstitial lung disease during biological treatment in Japanese patients with psoriasis
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DOI：
10.1111/ced.14259
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发表时间：
2020-06-29
影响因子：
4.1
通讯作者：
Okubo, Y.
中科院分区：
文献类型：
--
作者：
Matsumoto, Y.;Abe, N.;Okubo, Y.
背景随着越来越多的生物制剂用于治疗银屑病，与生物制剂相关的间质性肺病（ILD）患者数量也有所增加。其中许多病例与肿瘤坏死因子（TNF）-α抑制剂相关，但日本也报告了与其他生物制剂家族相关的病例。目的分析间质性肺疾病（ILD）的背景因素，探讨更好的生物治疗方法。方法回顾性分析246例银屑病患者使用生物制剂治疗的肺部不良事件。提取发生ILD的患者数据，分析背景因素、银屑病临床类型、至ILD发作时间、既存ILD、吸烟习惯和处方药物。结果22例患者发生肺部AE，其中11例诊断为药物性ILD。致病药物主要为TNF-α抑制剂，占8例病例（6例接受英夫利西单抗治疗，2例接受阿达木单抗治疗）。其余3例病例与阿基诺单抗、乌司奴单抗和ixekizumab相关（各n = 1）。值得注意的是，这3例病例也有药物诱导的ILD病史。结论有药物性ILD病史的患者更容易发生生物制剂性ILD，即使使用白细胞介素17抑制剂治疗也是如此。彻底筛查风险因素和评估合格性，以及治疗期间的仔细监测是避免严重肺部AE的最佳解决方案。肺部AE的早期检测和精确诊断，特别是与感染性疾病的鉴别，对于管理生物治疗至关重要。
Background With the increasing use of biological agents for the treatment of psoriasis, the numbers of patients with interstitial lung disease (ILD) associated with biologics have also increased. Many of these cases were associated with tumour necrosis factor (TNF)-alpha inhibitors, but cases associated with other families of biologics have also been reported in Japan. Aim To analyse the background factors of patients who developed ILD, and to discuss better management of biological treatment. Method We reviewed 246 patients with psoriasis who were treated with biological agents in our department to identify any pulmonary adverse events (AEs). Data on patients who developed ILD were extracted to analyse background factors, clinical type of psoriasis, time to onset of ILD, pre-existing ILD, smoking habit and prescribed drugs. Results Pulmonary AEs were seen in 22 cases, of which 11 were diagnosed as drug-induced ILD. The causative drugs were mainly TNF-alpha inhibitors, accounting for eight cases (six treated with infliximab, two with adalimumab). The remaining three cases were associated with secukinumab, ustekinumab and ixekizumab (n = 1 each). Notably, these three cases also had a history of drug-induced ILD. Conclusion Patients with a history of drug-induced ILD seem to be more susceptible to developing another ILD induced by biologics, even if treated with interleukin-17 inhibitors. Thorough screening of risk factors and evaluation for eligibility, and careful monitoring during treatment are the best solutions to avoid serious pulmonary AE. Early detection and precise diagnosis of pulmonary AEs, especially differentiation from infectious diseases, is essential for managing biological treatment.