title: Biologics-induced interstitial lung diseases in rheumatic patients: facts and controversies.
abstract: Interstitial lung disease (ILD) is a common, devastating pulmonary complication. An increased number of reports suggesting that biological disease modifying antirheumatic drugs (DMARDs) induced or exacerbated ILDs in rheumatoid arthritis (RA) patients has garnered increased attention. Areas covered: This article discusses ILDs induced by or exacerbated during biological therapy in RA patients. The article summarizes the efficacy and safety of a variety of licensed and off-label biologics clinically used for rheumatic diseases, focusing on the onset or exacerbation of RA-associated ILDs (RA-ILDs) in RA patients treated with biologics targeting tumor necrosis factor, CD20, interleukin 1 (IL-1) and IL-6 receptors. Additionally, the pathogenesis of RA-ILDs is discussed. Expert opinion: To some extent, the possibility of biologic-induced RA-ILDs increases the difficulty in choosing an optimal regimen for RA treatment with biological agents, as the relationship between biological therapy safety and the induction or exacerbation of RA-ILDs has not been established. A framework to assess baseline disease severity, particularly standardizing the evaluation of the pulmonary condition stage in RA patients and monitoring the outcome during the biological therapy treatment, is highly needed and may substantially help guide treatment decisions and predict the treatment benefits.
authors.affiliation: a Department of Pulmonary and Critical Care Medicine , General Hospital of Ningxia Medical University , Yinchuan , China.
authors.forename: Juan
authors.initials: J
authors.lastname: Chen
authors.affiliation: b Department of Rheumatology , General Hospital of Ningxia Medical University , Yinchuan , China.
authors.forename: Shuhong
authors.initials: S
authors.lastname: Chi
authors.affiliation: c Center of Laboratory Medicine , General Hospital of Ningxia Medical University , Yinchuan , Ningxia , China.
authors.forename: Feng
authors.initials: F
authors.lastname: Li
authors.affiliation: c Center of Laboratory Medicine , General Hospital of Ningxia Medical University , Yinchuan , Ningxia , China.|d Human Stem Cell Institute , General Hospital of Ningxia Medical University , Yinchuan , Ningxia , China.
authors.forename: Jiali
authors.initials: J
authors.lastname: Yang
authors.affiliation: e Department of Clinical Oncology , Queen Elizabeth Hospital , Kowloon , Hong Kong.
authors.forename: William C
authors.initials: WC
authors.lastname: Cho
authors.affiliation: c Center of Laboratory Medicine , General Hospital of Ningxia Medical University , Yinchuan , Ningxia , China.|d Human Stem Cell Institute , General Hospital of Ningxia Medical University , Yinchuan , Ningxia , China.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Liu
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy* / Q000235:genetics / Q000276:immunology; D001688:Biological Products / Q000009:adverse effects* / Q000627:therapeutic use; D016207:Cytokines / Q000235:genetics / Q000276:immunology; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000209:etiology* / Q000235:genetics / Q000276:immunology
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D016207:Cytokines
keywords: Anti-TNF; RA-ILD; autoimmune disease; biological therapy; immunosuppressive therapy; interstitial lung disease; rheumatoid arthritis