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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Bibliographic Details
Published in:Chest Vol. 151; no. 3; p. 619
Main Authors: 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
Format: Journal Article
Language:English
Published: United States 01.03.2017
Subjects:
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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Summary: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.
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ISSN:1931-3543
1931-3543
DOI:10.1016/j.chest.2016.10.029