Addition of antifibrotic therapy to immunosuppression in hypersensitivity pneumonitis: A case series

Hypersensitivity pneumonitis has historically been treated with immunosuppression, but recently nintedanib was approved for the treatment of progressive fibrotic HP. One limitation of INBUILD is that the only immunosuppression (IS) permitted at the time of enrollment was glucocorticoids at a dose of...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Margaret Kypreos, Tyonn Barbera, Chad A. Newton, Craig S. Glazer, Traci N. Adams
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Hypersensitivity pneumonitis Immunosuppression Interstitial lung disease Diseases of the respiratory system RC705-779
Acceso en línea:	https://doaj.org/article/6db563928dc3474b9d738cf2abd5d1d5
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:6db563928dc3474b9d738cf2abd5d1d5
record_format	dspace
spelling	oai:doaj.org-article:6db563928dc3474b9d738cf2abd5d1d52021-12-04T04:33:58ZAddition of antifibrotic therapy to immunosuppression in hypersensitivity pneumonitis: A case series2213-007110.1016/j.rmcr.2021.101562https://doaj.org/article/6db563928dc3474b9d738cf2abd5d1d52021-01-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2213007121002240https://doaj.org/toc/2213-0071Hypersensitivity pneumonitis has historically been treated with immunosuppression, but recently nintedanib was approved for the treatment of progressive fibrotic HP. One limitation of INBUILD is that the only immunosuppression (IS) permitted at the time of enrollment was glucocorticoids at a dose of less than 20mg per day, so the additive effect of antifibrotic (AF) therapy to IS in HP remains unclear. We present 5 cases of patients with HP for whom AF therapy was added to IS. Trends observed in the cohort include reduced decline in FVC, oxygen requirement, and symptoms in the year after adding AF to IS in 4 of the 5 patients. All 5 patients (100%) in our series demonstrated progression in the year prior to initiation of antifibrotic based on criteria outlined in the INBUILD trial, but only 1 of 5 (20%) progressed in the year after AF. There was a significant decrease in the rate of relative decline in % predicted FVC in the 12 months after initiation of antifibrotic compared to the 12 months prior to antifibrotic (0.4% ±7.6 vs −17.5% ±7.6, p = 0.0495). Compared to the 12 months prior to antifibrotic therapy, fewer patients met criteria for progression in the 12 months after initiating antifibrotic therapy (p = 0.048). Similarly, fewer patients met criteria for progression in the 6 months after initiating antifibrotic therapy compared to the 6 months prior (p = 0.048). A larger study with control groups on IS alone and AF alone is needed to confirm the role of AF therapy in combination with IS in patients with HP.Margaret KypreosTyonn BarberaChad A. NewtonCraig S. GlazerTraci N. AdamsElsevierarticleHypersensitivity pneumonitisImmunosuppressionInterstitial lung diseaseDiseases of the respiratory systemRC705-779ENRespiratory Medicine Case Reports, Vol 34, Iss , Pp 101562- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Hypersensitivity pneumonitis Immunosuppression Interstitial lung disease Diseases of the respiratory system RC705-779
spellingShingle	Hypersensitivity pneumonitis Immunosuppression Interstitial lung disease Diseases of the respiratory system RC705-779 Margaret Kypreos Tyonn Barbera Chad A. Newton Craig S. Glazer Traci N. Adams Addition of antifibrotic therapy to immunosuppression in hypersensitivity pneumonitis: A case series
description	Hypersensitivity pneumonitis has historically been treated with immunosuppression, but recently nintedanib was approved for the treatment of progressive fibrotic HP. One limitation of INBUILD is that the only immunosuppression (IS) permitted at the time of enrollment was glucocorticoids at a dose of less than 20mg per day, so the additive effect of antifibrotic (AF) therapy to IS in HP remains unclear. We present 5 cases of patients with HP for whom AF therapy was added to IS. Trends observed in the cohort include reduced decline in FVC, oxygen requirement, and symptoms in the year after adding AF to IS in 4 of the 5 patients. All 5 patients (100%) in our series demonstrated progression in the year prior to initiation of antifibrotic based on criteria outlined in the INBUILD trial, but only 1 of 5 (20%) progressed in the year after AF. There was a significant decrease in the rate of relative decline in % predicted FVC in the 12 months after initiation of antifibrotic compared to the 12 months prior to antifibrotic (0.4% ±7.6 vs −17.5% ±7.6, p = 0.0495). Compared to the 12 months prior to antifibrotic therapy, fewer patients met criteria for progression in the 12 months after initiating antifibrotic therapy (p = 0.048). Similarly, fewer patients met criteria for progression in the 6 months after initiating antifibrotic therapy compared to the 6 months prior (p = 0.048). A larger study with control groups on IS alone and AF alone is needed to confirm the role of AF therapy in combination with IS in patients with HP.
format	article
author	Margaret Kypreos Tyonn Barbera Chad A. Newton Craig S. Glazer Traci N. Adams
author_facet	Margaret Kypreos Tyonn Barbera Chad A. Newton Craig S. Glazer Traci N. Adams
author_sort	Margaret Kypreos
title	Addition of antifibrotic therapy to immunosuppression in hypersensitivity pneumonitis: A case series
title_short	Addition of antifibrotic therapy to immunosuppression in hypersensitivity pneumonitis: A case series
title_full	Addition of antifibrotic therapy to immunosuppression in hypersensitivity pneumonitis: A case series
title_fullStr	Addition of antifibrotic therapy to immunosuppression in hypersensitivity pneumonitis: A case series
title_full_unstemmed	Addition of antifibrotic therapy to immunosuppression in hypersensitivity pneumonitis: A case series
title_sort	addition of antifibrotic therapy to immunosuppression in hypersensitivity pneumonitis: a case series
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/6db563928dc3474b9d738cf2abd5d1d5
work_keys_str_mv	AT margaretkypreos additionofantifibrotictherapytoimmunosuppressioninhypersensitivitypneumonitisacaseseries AT tyonnbarbera additionofantifibrotictherapytoimmunosuppressioninhypersensitivitypneumonitisacaseseries AT chadanewton additionofantifibrotictherapytoimmunosuppressioninhypersensitivitypneumonitisacaseseries AT craigsglazer additionofantifibrotictherapytoimmunosuppressioninhypersensitivitypneumonitisacaseseries AT tracinadams additionofantifibrotictherapytoimmunosuppressioninhypersensitivitypneumonitisacaseseries
_version_	1718372973657718784

Addition of antifibrotic therapy to immunosuppression in hypersensitivity pneumonitis: A case series

Ejemplares similares