PT - JOURNAL ARTICLE AU - Mankikian, Julie AU - Caille, Agnès AU - Reynaud-Gaubert, Martine AU - Agier, Marie-Sara AU - Bermudez, Julien AU - Bonniaud, Philippe AU - Borie, Raphael AU - Brillet, Pierre-Yves AU - Cadranel, Jacques AU - Court-Fortune, Isabelle AU - Crestani, Bruno AU - Debray, Marie-Pierre AU - Gomez, Emmanuel AU - Gondouin, Anne AU - Hirschi-Santelmo, Sandrine AU - Israel-Biet, Dominique AU - Jouneau, Stéphane AU - Juvin, Karine AU - Leger, Julie AU - Kerjouan, Mallorie AU - Marquette, Charles-Hugo AU - Naccache, Jean-Marc AU - Nunes, Hilario AU - Plantier, Laurent AU - Prevot, Grégoire AU - Quetant, Sébastien AU - Traclet, Julie AU - Valentin, Victor AU - Uzunhan, Yurdagul AU - Wémeau-Stervinou, Lidwine AU - Bejan-Angoulvant, Theodora AU - Cottin, Vincent AU - Marchand-Adam, Sylvain ED - , TI - Rituximab and mycophenolate mofetil combination in patients with interstitial lung disease (EVER-ILD): a double-blind, randomised, placebo-controlled trial AID - 10.1183/13993003.02071-2022 DP - 2023 Jun 01 TA - European Respiratory Journal PG - 2202071 VI - 61 IP - 6 4099 - http://erj.ersjournals.com/content/61/6/2202071.short 4100 - http://erj.ersjournals.com/content/61/6/2202071.full SO - Eur Respir J2023 Jun 01; 61 AB - Background Standard of care for interstitial lung disease (ILD) with a nonspecific interstitial pneumonia (NSIP) pattern proposes mycophenolate mofetil (MMF) as one of the first-step therapies while rituximab is used as rescue therapy.Methods In a randomised, double-blind, two-parallel group, placebo-controlled trial (NCT02990286), patients with connective tissue disease-associated ILD or idiopathic interstitial pneumonia (with or without autoimmune features) and a NSIP pattern (defined on NSIP pathological pattern or on integration of clinicobiological data and a NSIP-like high-resolution computed tomography pattern) were randomly assigned in a 1:1 ratio to receive rituximab (1000 mg) or placebo on day 1 and day 15 in addition to MMF (2 g daily) for 6 months. The primary end-point was the change in percent predicted forced vital capacity (FVC) from baseline to 6 months analysed by a linear mixed model for repeated measures analysis. Secondary end-points included progression-free survival (PFS) up to 6 months and safety.Findings Between January 2017 and January 2019, 122 randomised patients received at least one dose of rituximab (n=63) or placebo (n=59). The least-squares mean change from baseline to 6 months in FVC (% predicted) was +1.60 (se 1.13) in the rituximab+MMF group and −2.01 (se 1.17) in the placebo+MMF group (between-group difference 3.60, 95% CI 0.41–6.80; p=0.0273). PFS was better in the rituximab+MMF group (crude hazard ratio 0.47, 95% CI 0.23–0.96; p=0.03). Serious adverse events occurred in 26 (41%) patients of the rituximab+MMF group and in 23 (39%) of the placebo+MMF group. Nine infections were reported in the rituximab+MMF group (five bacterial infections, three viral infections, one other) and four bacterial infections in the placebo+MMF group.Interpretation Combination of rituximab and MMF was superior to MMF alone in patients with ILD and a NSIP pattern. The use of this combination must take into consideration the risk of viral infection.Rituximab plus MMF is associated with benefits in lung function and progression-free survival compared with MMF plus placebo after 24 weeks of treatment. The safety profile of rituximab plus MMF was similar to that of MMF plus placebo. http://bit.ly/3zcozku