■类风湿性关节炎(RA)伴有间质性肺病(ILD)的预后特别差。虽然不有助于ILD进展的药物应用于RA治疗,没有建立。这项研究评估了托珠单抗在ILD活性方面的安全性。
这项研究前瞻性招募了2014年4月至2022年6月在Dokkyo医科大学Saitama医学中心接受托珠单抗治疗的所有55例RA合并ILD患者。结果测量是MMP-3和KL-6作为RA和ILD活性的生物标志物,分别,并分析了它们之间的关系。
■治疗6个月时MMP-3和KL-6均有明显改善(分别为P<0.001和P<0.05),MMP-3与KL-6的相关性较弱(R2=0.086,P=0.087)。与RA改善组相比,RA进展导致MMP-3增加的组在6个月时KL-6明显升高(P<0.05)。此外,与ILD改善或无改变的组相比,计算机断层扫描显示ILD进展组的MMP-3明显升高(分别为P<0.05和P<0.01)。6个月死亡率为0%,1年2.0%,两年时16.7%,3年时为32.4%,和因呼吸道感染引起的ILD急性加重的死亡率随时间增加。
■在治疗6个月时发现RA活性和ILD活性相关。Tocilizumab似乎不影响ILD进展的机制,因为大多数患者在6个月内使用托珠单抗显示MMP-3和KL-6的改善,预计这种药物会直接影响肺部。然而,治疗开始后1年呼吸道感染加重ILD.作为免疫抑制药物,包括托珠单抗,有呼吸道感染的风险,识别感染的早期迹象很重要。
UNASSIGNED: The prognosis of rheumatoid arthritis (RA) with interstitial lung disease (ILD) is particularly poor. Although drugs that do not contribute to the progression of ILD should be used in RA treatment, none have been established. This study evaluated the safety of
tocilizumab in terms of ILD activity.
UNASSIGNED: This study prospectively enrolled all 55 patients with RA complicated by ILD who were treated with
tocilizumab at Dokkyo Medical University Saitama Medical Center from April 2014 to June 2022. The outcome measures were MMP-3 and KL-6 as biomarkers of RA and ILD activity, respectively, and the relationship between them was analyzed.
UNASSIGNED: Both MMP-3 and KL-6 were significantly improved at 6 months of treatment (P < 0.001 and P < 0.05, respectively), and a weak correlation between MMP-3 and KL-6 was observed (R2 = 0.086, P = 0.087). The group with increased MMP-3 due to RA progression had significantly higher KL-6 at 6 months compared with the group with RA improvement (P < 0.05). Also, the group with ILD progression on computed tomography had significantly higher MMP-3 compared with the groups with improvement or no change of ILD (P < 0.05 and P < 0.01, respectively). The mortality rate was 0% at 6 months, 2.0% at 1 year, 16.7% at 2 years, and 32.4% at 3 years, and mortality from acute exacerbation of ILD due to respiratory infection increased over time.
UNASSIGNED: RA activity and ILD activity were found to be related at 6 months of treatment.
Tocilizumab does not seem to affect the mechanism of ILD progression, as most patients showed improvement in both MMP-3 and KL-6 with
tocilizumab within 6 months, when this drug would be expected to affect the lungs directly. However, respiratory infection exacerbated ILD from 1 year after the start of treatment. As immunosuppressive drugs, including
tocilizumab, have a risk of respiratory infection, it is important to identify early signs of infection.