Use of Mycophenolate Mofetil or Azathioprine for the Management of Chronic Hypersensitivity Pneumonitis

The treatment of chronic hypersensitivity pneumonitis (cHP) often includes systemic oral corticosteroids, but the optimal pharmacologic management remains unclear. The morbidity associated with prednisone has motivated the search for alternative therapies. We aimed to determine the effect of treatme...

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Vydáno v:	Chest Ročník 151; číslo 3; s. 619
Hlavní autoři:	Morisset, Julie, Johannson, Kerri A, Vittinghoff, Eric, Aravena, Carlos, Elicker, Brett M, Jones, Kirk D, Fell, Charlene D, Manganas, Helene, Dubé, Bruno-Pierre, Wolters, Paul J, Collard, Harold R, Ryerson, Christopher J, Ley, Brett
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States 01.03.2017
Témata:	Aged Alveolitis, Extrinsic Allergic - drug therapy Alveolitis, Extrinsic Allergic - physiopathology Azathioprine - therapeutic use Carbon Monoxide Chronic Disease Female Glucocorticoids - therapeutic use Humans Immunosuppressive Agents - therapeutic use Linear Models Male Middle Aged Mycophenolic Acid - therapeutic use Prednisone - therapeutic use Pulmonary Diffusing Capacity Retrospective Studies Treatment Outcome Vital Capacity azathioprine mycophenolate mofetil hypersensitivity pneumonitis interstitial lung disease
ISSN:	1931-3543, 1931-3543
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Abstract	The treatment of chronic hypersensitivity pneumonitis (cHP) often includes systemic oral corticosteroids, but the optimal pharmacologic management remains unclear. The morbidity associated with prednisone has motivated the search for alternative therapies. We aimed to determine the effect of treatment with mycophenolate mofetil (MMF) or azathioprine (AZA) on lung function in patients with cHP. Patients with cHP treated with either MMF or AZA were retrospectively identified from four interstitial lung disease centers. Change in lung function before and after treatment initiation was analyzed using linear mixed-effects modeling (LMM), adjusting for age, sex, smoking history, and prednisone use. Seventy patients were included: 51 were treated with MMF and 19 with AZA. Median follow-up after treatment initiation was 11 months. Prior to treatment initiation, FVC and diffusion capacity of the lung for carbon monoxide (Dlco) % predicted were declining at a mean rate of 0.12% (P < .001) and 0.10% (P < .001) per month, respectively. Treatment with either MMF or AZA was not associated with improved FVC (0.5% at 1 year; P = .46) but was associated with a statistically significant improvement in Dlco of 4.2% (P < .001) after 1 year of treatment. Results were similar in the subgroup of patients treated with MMF for 1 year; the FVC increased nonsignificantly by 1.3% (P = .103) and Dlco increased by 3.9% (P < .001). Treatment with MMF or AZA is associated with improvements in Dlco in patients with cHP. Prospective randomized trials are needed to validate their effectiveness for cHP.
AbstractList	The treatment of chronic hypersensitivity pneumonitis (cHP) often includes systemic oral corticosteroids, but the optimal pharmacologic management remains unclear. The morbidity associated with prednisone has motivated the search for alternative therapies. We aimed to determine the effect of treatment with mycophenolate mofetil (MMF) or azathioprine (AZA) on lung function in patients with cHP. Patients with cHP treated with either MMF or AZA were retrospectively identified from four interstitial lung disease centers. Change in lung function before and after treatment initiation was analyzed using linear mixed-effects modeling (LMM), adjusting for age, sex, smoking history, and prednisone use. Seventy patients were included: 51 were treated with MMF and 19 with AZA. Median follow-up after treatment initiation was 11 months. Prior to treatment initiation, FVC and diffusion capacity of the lung for carbon monoxide (Dlco) % predicted were declining at a mean rate of 0.12% (P < .001) and 0.10% (P < .001) per month, respectively. Treatment with either MMF or AZA was not associated with improved FVC (0.5% at 1 year; P = .46) but was associated with a statistically significant improvement in Dlco of 4.2% (P < .001) after 1 year of treatment. Results were similar in the subgroup of patients treated with MMF for 1 year; the FVC increased nonsignificantly by 1.3% (P = .103) and Dlco increased by 3.9% (P < .001). Treatment with MMF or AZA is associated with improvements in Dlco in patients with cHP. Prospective randomized trials are needed to validate their effectiveness for cHP. The treatment of chronic hypersensitivity pneumonitis (cHP) often includes systemic oral corticosteroids, but the optimal pharmacologic management remains unclear. The morbidity associated with prednisone has motivated the search for alternative therapies. We aimed to determine the effect of treatment with mycophenolate mofetil (MMF) or azathioprine (AZA) on lung function in patients with cHP.BACKGROUNDThe treatment of chronic hypersensitivity pneumonitis (cHP) often includes systemic oral corticosteroids, but the optimal pharmacologic management remains unclear. The morbidity associated with prednisone has motivated the search for alternative therapies. We aimed to determine the effect of treatment with mycophenolate mofetil (MMF) or azathioprine (AZA) on lung function in patients with cHP.Patients with cHP treated with either MMF or AZA were retrospectively identified from four interstitial lung disease centers. Change in lung function before and after treatment initiation was analyzed using linear mixed-effects modeling (LMM), adjusting for age, sex, smoking history, and prednisone use.METHODSPatients with cHP treated with either MMF or AZA were retrospectively identified from four interstitial lung disease centers. Change in lung function before and after treatment initiation was analyzed using linear mixed-effects modeling (LMM), adjusting for age, sex, smoking history, and prednisone use.Seventy patients were included: 51 were treated with MMF and 19 with AZA. Median follow-up after treatment initiation was 11 months. Prior to treatment initiation, FVC and diffusion capacity of the lung for carbon monoxide (Dlco) % predicted were declining at a mean rate of 0.12% (P < .001) and 0.10% (P < .001) per month, respectively. Treatment with either MMF or AZA was not associated with improved FVC (0.5% at 1 year; P = .46) but was associated with a statistically significant improvement in Dlco of 4.2% (P < .001) after 1 year of treatment. Results were similar in the subgroup of patients treated with MMF for 1 year; the FVC increased nonsignificantly by 1.3% (P = .103) and Dlco increased by 3.9% (P < .001).RESULTSSeventy patients were included: 51 were treated with MMF and 19 with AZA. Median follow-up after treatment initiation was 11 months. Prior to treatment initiation, FVC and diffusion capacity of the lung for carbon monoxide (Dlco) % predicted were declining at a mean rate of 0.12% (P < .001) and 0.10% (P < .001) per month, respectively. Treatment with either MMF or AZA was not associated with improved FVC (0.5% at 1 year; P = .46) but was associated with a statistically significant improvement in Dlco of 4.2% (P < .001) after 1 year of treatment. Results were similar in the subgroup of patients treated with MMF for 1 year; the FVC increased nonsignificantly by 1.3% (P = .103) and Dlco increased by 3.9% (P < .001).Treatment with MMF or AZA is associated with improvements in Dlco in patients with cHP. Prospective randomized trials are needed to validate their effectiveness for cHP.CONCLUSIONSTreatment with MMF or AZA is associated with improvements in Dlco in patients with cHP. Prospective randomized trials are needed to validate their effectiveness for cHP.
Author	Johannson, Kerri A Ley, Brett Vittinghoff, Eric Manganas, Helene Fell, Charlene D Jones, Kirk D Elicker, Brett M Dubé, Bruno-Pierre Aravena, Carlos Wolters, Paul J Morisset, Julie Collard, Harold R Ryerson, Christopher J
Author_xml	– sequence: 1 givenname: Julie surname: Morisset fullname: Morisset, Julie email: julie.morisset@umontreal.ca organization: Department of Medicine, University of California, San Francisco, San Francisco, CA; Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada. Electronic address: julie.morisset@umontreal.ca – sequence: 2 givenname: Kerri A surname: Johannson fullname: Johannson, Kerri A organization: Department of Medicine, University of Calgary, Calgary, AB, Canada – sequence: 3 givenname: Eric surname: Vittinghoff fullname: Vittinghoff, Eric organization: Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA – sequence: 4 givenname: Carlos surname: Aravena fullname: Aravena, Carlos organization: Department of Respiratory Diseases, Pontifical Catholic University of Chile, Santiago, Chile – sequence: 5 givenname: Brett M surname: Elicker fullname: Elicker, Brett M organization: Department of Radiology, University of California, San Francisco, San Francisco, CA – sequence: 6 givenname: Kirk D surname: Jones fullname: Jones, Kirk D organization: Department of Pathology, University of California, San Francisco, San Francisco, CA – sequence: 7 givenname: Charlene D surname: Fell fullname: Fell, Charlene D organization: Department of Medicine, University of Calgary, Calgary, AB, Canada – sequence: 8 givenname: Helene surname: Manganas fullname: Manganas, Helene organization: Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada – sequence: 9 givenname: Bruno-Pierre surname: Dubé fullname: Dubé, Bruno-Pierre organization: Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada – sequence: 10 givenname: Paul J surname: Wolters fullname: Wolters, Paul J organization: Department of Medicine, University of California, San Francisco, San Francisco, CA – sequence: 11 givenname: Harold R surname: Collard fullname: Collard, Harold R organization: Department of Medicine, University of California, San Francisco, San Francisco, CA – sequence: 12 givenname: Christopher J surname: Ryerson fullname: Ryerson, Christopher J organization: Department of Medicine and Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada – sequence: 13 givenname: Brett surname: Ley fullname: Ley, Brett organization: Department of Medicine, University of California, San Francisco, San Francisco, CA
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Copyright	Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
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SubjectTerms	Aged Alveolitis, Extrinsic Allergic - drug therapy Alveolitis, Extrinsic Allergic - physiopathology Azathioprine - therapeutic use Carbon Monoxide Chronic Disease Female Glucocorticoids - therapeutic use Humans Immunosuppressive Agents - therapeutic use Linear Models Male Middle Aged Mycophenolic Acid - therapeutic use Prednisone - therapeutic use Pulmonary Diffusing Capacity Retrospective Studies Treatment Outcome Vital Capacity
Title	Use of Mycophenolate Mofetil or Azathioprine for the Management of Chronic Hypersensitivity Pneumonitis
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