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Publication - Professor Ann Millar

    Rituximab in autoimmune connective tissue disease-associated interstitial lung disease

    Citation

    Sharp, C, McCabe, M, Dodds, N, Edey, A, Mayers, L, Adamali, H, Millar, AB & Gunawardena, H, 2016, ‘Rituximab in autoimmune connective tissue disease-associated interstitial lung disease’. Rheumatology, vol 55., pp. 1318-1324

    Abstract

    Objective. CTD-associated interstitial lung
    disease (ILD) often fails to respond to conventional immunomodulatory
    agents. There is now
    considerable interest in the use of rituximab in
    systemic autoimmune CTD in patients refractory to standard treatments.
    The
    aim of this study was to review the experience of
    North Bristol NHS Trust managing patients with CTD-associated ILD with
    rituximab
    and explore possible associations with treatment
    response.


    Methods. We conducted a
    retrospective analysis of all patients who received rituximab under the
    Bristol CTD-ILD service, having failed
    to respond to other immunomodulatory treatments.
    Results were collated for pulmonary function and radiological outcomes
    before
    and after treatment.


    Results. Twenty-four
    patients were treated with rituximab. Their physiological parameters had
    failed to improve despite other immunomodulatory
    agents, with a mean change in forced vital capacity
    (FVC) prior to therapy of − 3.3% (95% CI − 5.6, −1.1) and mean change
    in diffusing capacity of carbon monoxide of − 4.3%
    (95% CI − 7.7, −0.9). After rituximab, radiology remained stable or
    improved
    for 11 patients, while worsening was observed in 9
    patients. The decline in FVC was halted following treatment, with a mean
    change of + 4.1% (95% CI 0.9, 7.2), while diffusing
    capacity of carbon monoxide was stable [mean change +2.1% (95% CI −
    1.0,
    5.2)]. Patients with myositis overlap or
    antisynthetase syndrome appeared to respond well to treatment, with four
    patients
    showing clinically significant improvement in FVC
    >10%.


    Conclusion. Rituximab is a therapeutic option in treatment-refractory CTD-associated ILD. Some disease subgroups may respond better than
    others, however, more work is needed to define its role in managing these patients.

    Full details in the University publications repository