The safety of biologic therapies in RA-associated interstitial lung disease

Meghna Jani, Nikhil Hirani, Eric L Matteson, William G Dixon

Research output: Contribution to journalLiterature reviewpeer-review

Abstract

Interstitial lung disease (ILD) is a common extra-articular manifestation associated with increased morbidity and mortality in patients with rheumatoid arthritis (RA). Early case reports of serious respiratory adverse events (SRAEs) following treatment with anti-TNF agents have led to concerns about biologic therapy in patients with RA-associated ILD (RA-ILD), and a tendency for biologic agents targeting factors other than TNF to be prescribed in such patients. At present, the appropriateness of such decisions is not clear. Given that the therapeutic goal for RA is remission, clinicians increasingly face the challenge of choosing the optimal biologic agent in patients with RA-ILD and uncontrolled joint disease. However, no evidence-based guidelines exist to guide physicians in deciding whether to commence biologic therapy in this setting, or in selecting which drug is most appropriate. Herein, we review the evidence for the comparative pulmonary safety of anti-TNF agents and non-TNF-targeting biologic agents in RA-ILD. In addition, we propose a framework for assessment of baseline disease severity to guide treatment decisions, and for monitoring during therapy. Because of substantial gaps in the available evidence, we also describe a research agenda aimed at obtaining data that will help inform future clinical practice.

Original languageEnglish
Pages (from-to)284-94
Number of pages11
JournalNature Reviews Rheumatology
Volume10
Issue number5
DOIs
Publication statusPublished - May 2014

Keywords

  • Arthritis, Rheumatoid
  • Biological Factors
  • Humans
  • Lung Diseases, Interstitial

Fingerprint

Dive into the research topics of 'The safety of biologic therapies in RA-associated interstitial lung disease'. Together they form a unique fingerprint.

Cite this