TY - JOUR T1 - Outcomes of immunosuppressive therapy in chronic hypersensitivity pneumonitis JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00016-2017 VL - 3 IS - 3 SP - 00016-2017 AU - Ayodeji Adegunsoye AU - Justin M. Oldham AU - Evans R. Fernández Pérez AU - Mark Hamblin AU - Nina Patel AU - Mitchell Tener AU - Deepa Bhanot AU - Lacey Robinson AU - Sam Bullick AU - Lena Chen AU - Scully Hsu AU - Matthew Churpek AU - Donald Hedeker AU - Steven Montner AU - Jonathan H. Chung AU - Aliya N. Husain AU - Imre Noth AU - Mary E. Strek AU - Rekha Vij Y1 - 2017/07/01 UR - http://openres.ersjournals.com/content/3/3/00016-2017.abstract N2 - 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 ER -