title: Pulmonary disorders induced by monoclonal antibodies in patients with rheumatologic autoimmune diseases.
abstract: Monoclonal antibodies have emerged as a new class of agents causing drug-related pulmonary involvement in patients with systemic rheumatologic autoimmune diseases. The most frequently associated noninfectious pulmonary diseases are interstitial pneumonia (118 cases reported by August 2010), sarcoid-like disease and vasculitis (40 cases), and 97% of cases are associated with agents blocking tumor necrosis factor (TNF), a cytokine implicated in pulmonary fibrosis, granuloma formation, and maintenance. Drug-induced interstitial pneumonia has a poor prognosis, with an overall mortality rate of around one-third, rising to two-thirds in patients with pre-existing interstitial disease. Sarcoid-like disease has a better prognosis, with resolution or improvement in 90% of cases. Although the evidence comes overwhelmingly from case reports and case series, suggested recommendations for patient management include a detailed pre-therapeutic evaluation, early identification of symptoms suggestive of pulmonary disease, and tailored therapy. Mycobacterial infection should be exhaustively investigated, especially after anti-TNF administration. Large, prospective, postmarketing studies including nonbiological agents as controls may help elucidate the real risk of pulmonary disease in patients with rheumatologic autoimmune diseases receiving monoclonal antibodies.
authors.affiliation: Department of Autoimmune Diseases, Laboratory of Autoimmune Diseases Josep Font, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Ramos-Casals
authors.forename: Roberto
authors.initials: R
authors.lastname: Perez-Alvarez
authors.forename: Marta
authors.initials: M
authors.lastname: Perez-de-Lis
authors.forename: Antoni
authors.initials: A
authors.lastname: Xaubet
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D001327:Autoimmune Diseases / Q000188:drug therapy*; D042241:Early Diagnosis; D006801:Humans; D008171:Lung Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology*; D017563:Lung Diseases, Interstitial / Q000139:chemically induced / Q000503:physiopathology; D011379:Prognosis; D012216:Rheumatic Diseases / Q000188:drug therapy*; D017565:Sarcoidosis, Pulmonary / Q000139:chemically induced / Q000503:physiopathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014657:Vasculitis / Q000139:chemically induced / Q000503:physiopathology
chemical_list: D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha