title: Effect of rituximab on pulmonary function in patients with rheumatoid arthritis.
abstract: Rituximab (RTX), a B-cell depleting monoclonal antibody is increasingly used in several antibody-mediated diseases. It has been reported to cause pulmonary toxicity, though mainly during polychemotherapy of malignant lymphoma. Prospective data on RTX-induced pulmonary complications in patients with rheumatoid arthritis (RA) are lacking.
  
  
  
  Serial spirometries and measurements of diffusion capacity of the lung for carbon monoxide (DLCO) in patients with RA before and 2, 4, 8, and 26 weeks after treatment with RTX were performed. A reduction from baseline of forced vital capacity (FVC) of ≥10%, or ≥15% of DLCO was defined as indicative for pulmonary toxicity.
  
  
  
  Thirty-three patients (mean (SD) age 59 (12) years, 27% males) were included. Mean (SD) FVC predicted and DLCO predicted at baseline were 108% (18%) and 88% (18%), respectively. In contrast to FVC, DLCO showed a progressive decline during follow-up with a maximum reduction of 6.1% (95%CI 2.5%, 9.7%; p = 0.001) at 26 weeks compared with baseline. After 26 weeks, 22% of the patients had a ≥15% DLCO decline. None of the patients reported increased dyspnea during follow-up. Risk factors for pulmonary function changes after treatment with RTX were cigarette smoking, repeated administration of the drug, and co-medication with Prednisone.
  
  
  
  Although no cases of symptomatic lung injury were observed, the progressive DLCO decline seems to indicate the presence of subclinical RTX-induced pulmonary toxicity.
authors: Division of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. Electronic address: daniel.franzen@usz.ch.
authors: Daniel
authors: D
authors: Franzen
authors: Department of Rheumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. Electronic address: adrian.ciurea@usz.ch.
authors: Adrian
authors: A
authors: Ciurea
authors: Division of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. Electronic address: daniel.bratton@usz.ch.
authors: Daniel J
authors: DJ
authors: Bratton
authors: Division of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. Electronic address: christian.clarenbach@usz.ch.
authors: Christian F
authors: CF
authors: Clarenbach
authors: Division of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. Electronic address: tsogyal.latshang@ksgr.ch.
authors: Tsogyal D
authors: TD
authors: Latshang
authors: Division of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. Electronic address: erich.russi@usz.ch.
authors: Erich W
authors: EW
authors: Russi
authors: Department of Rheumatology, University Hospital Basel, Spitalstrasse 21, 4056, Basel, Switzerland. Electronic address: diego.kyburz@usb.ch.
authors: Diego
authors: D
authors: Kyburz
authors: Division of Pulmonology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. Electronic address: malcolm.kohler@usz.ch.
authors: Malcolm
authors: M
authors: Kohler
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000503:physiopathology; D002248:Carbon Monoxide / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008171:Lung Diseases / Q000139:chemically induced* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012307:Risk Factors; D000069283:Rituximab / Q000009:adverse effects / Q000627:therapeutic use*; D012907:Smoking / Q000453:epidemiology; D013147:Spirometry; D013997:Time Factors; D014797:Vital Capacity
chemical_list: D018501:Antirheumatic Agents; D000069283:Rituximab; D002248:Carbon Monoxide; D011241:Prednisone
keywords: Diffusion capacity; Lung injury; Pulmonary toxicity; Rheumatoid arthritis; Rituximab; Spirometry