RT Journal Article
SR Electronic
T1 Outcomes of immunosuppressive therapy in chronic hypersensitivity pneumonitis
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00016-2017
DO 10.1183/23120541.00016-2017
VO 3
IS 3
A1 Ayodeji Adegunsoye
A1 Justin M. Oldham
A1 Evans R. Fernández Pérez
A1 Mark Hamblin
A1 Nina Patel
A1 Mitchell Tener
A1 Deepa Bhanot
A1 Lacey Robinson
A1 Sam Bullick
A1 Lena Chen
A1 Scully Hsu
A1 Matthew Churpek
A1 Donald Hedeker
A1 Steven Montner
A1 Jonathan H. Chung
A1 Aliya N. Husain
A1 Imre Noth
A1 Mary E. Strek
A1 Rekha Vij
YR 2017
UL http://openres.ersjournals.com/content/3/3/00016-2017.abstract
AB In chronic hypersensitivity pneumonitis (CHP), lack of improvement or declining lung function may prompt use of immunosuppressive therapy. We hypothesised that use of azathioprine or mycophenolate mofetil with prednisone reduces adverse events and lung function decline, and improves transplant-free survival.Patients with CHP were identified. Demographic features, pulmonary function tests, incidence of treatment-emergent adverse events (TEAEs) and transplant-free survival were characterised, compared and analysed between patients stratified by immunosuppressive therapy. A multicentre comparison was performed across four independent tertiary medical centres.Among 131 CHP patients at the University of Chicago medical centre (Chicago, IL, USA), 93 (71%) received immunosuppressive therapy, and had worse baseline forced vital capacity (FVC) and diffusing capacity, and increased mortality compared with those who did not. Compared to patients treated with prednisone alone, TEAEs were 54% less frequent with azathioprine therapy (p=0.04) and 66% less frequent with mycophenolate mofetil (p=0.002). FVC decline and survival were similar between treatment groups. Analyses of datasets from four external tertiary medical centres confirmed these findings.CHP patients who did not receive immunosuppressive therapy had better survival than those who did. Use of mycophenolate mofetil or azathioprine was associated with a decreased incidence of TEAEs, and no difference in lung function decline or survival when compared with prednisone alone. Early transition to mycophenolate mofetil or azathioprine may be an appropriate therapeutic approach in CHP, but more studies are needed.Early transition to mycophenolate mofetil or azathioprine may be an appropriate therapeutic approach in CHP http://ow.ly/kAN130dRIX8