Efficacy and safety of rituximab in the treatment of connective tissue disease-related interstitial lung disease

Article Details

Authors
Caterina Vacchi PhD, Andreina Manfredi MD, Giulia Cassone PhD, Gian Luca Erre MD, Carlo Salvarani MD, Marco Sebastiani MD

Article Type
Review

DOI
10.7573/dic.2020-8-7

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Abstract

Interstitial lung disease (ILD) represents a severe pulmonary complication of connective tissue diseases, rheumatoid arthritis (RA), and antineutrophil cytoplasmic antibodyassociated vasculitis. Treatment of ILD, mainly based on immunosuppression, remains challenging. Rituximab (RTX), a monoclonal antibody binding to CD20, is considered a valuable therapeutic choice in cases of refractory ILD. Here, we review the available efficacy and safety data on the use of RTX in the treatment of rheumatic disease-related ILD. Despite controversial efficacy data, RTX seems to be able to stabilize or improve ILD related to RA and antisynthetase syndrome and in established and severe ILD complicating systemic sclerosis. Fewer data are available regarding ILD related to Sjögren syndrome, systemic lupus erythematosus, and antineutrophil cytoplasmic antibody-associated vasculitis. To date, few prospective studies are available and randomized trials are still ongoing with the purpose of exploring the role of RTX in this condition, including the supposed relationship between efficacy and ILD radiologic patterns and safety data, up to now derived mainly from RA studies. Despite an overall acceptable safety profile, concerns remain regarding an increased infectious disease risk in patients with ILD as well as possible lung toxicity and the increased rate of immune-mediated reactions in patients with connective tissue diseases. In conclusion, RTX is a relevant therapeutic option for rheumatic disease-related ILD despite the existing uncertainties; ongoing trials are expected to clarify its use.

Keywords: connective tissue diseases, efficacy, interstitial lung disease, lung fibrosis, rheumatic diseases, rituximab, safety.

Citation: Vacchi C, Manfredi A, Cassone G, Erre GL, Salvarani C, Sebastiani M. Efficacy and safety of rituximab in the treatment of connective tissue disease-related interstitial lung disease. Drugs in Context 2021; 10: 2020-8-7. DOI: 10.7573/dic.2020-8-7

Contributions: Authors contributed significantly to the conception and design of article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest relevant to this manuscript. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2020/12/dic.2020-8-7-COI.pdf

Acknowledgements: None.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2021 Vacchi C, Manfredi A, Cassone G, Erre GL, Salvarani C, Sebastiani M. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2021 Vacchi C, Manfredi A, Cassone G, Erre GL, Salvarani C, Sebastiani M. https://doi.org/10.7573/dic.2020-8-7. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/efficacy-and-safety-of-rituximab-in-the-treatment-of-connective-tissue-disease-related-interstitial-lung-disease

Correspondence: Marco Sebastiani, Rheumatology Unit, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41100 Modena, Italy. marco.sebastiani@unimore.it

Provenance: Invited; externally peer reviewed.

Submitted: 31 August 2020; Accepted: 30 November 2020; Publication date: 15 January 2021.

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