RT Journal Article
SR Electronic
T1 Rituximab and mycophenolate mofetil combination in patients with interstitial lung disease (EVER-ILD): a double-blind, randomised, placebo-controlled trial
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 2202071
DO 10.1183/13993003.02071-2022
VO 61
IS 6
A1 Mankikian, Julie
A1 Caille, Agnès
A1 Reynaud-Gaubert, Martine
A1 Agier, Marie-Sara
A1 Bermudez, Julien
A1 Bonniaud, Philippe
A1 Borie, Raphael
A1 Brillet, Pierre-Yves
A1 Cadranel, Jacques
A1 Court-Fortune, Isabelle
A1 Crestani, Bruno
A1 Debray, Marie-Pierre
A1 Gomez, Emmanuel
A1 Gondouin, Anne
A1 Hirschi-Santelmo, Sandrine
A1 Israel-Biet, Dominique
A1 Jouneau, Stéphane
A1 Juvin, Karine
A1 Leger, Julie
A1 Kerjouan, Mallorie
A1 Marquette, Charles-Hugo
A1 Naccache, Jean-Marc
A1 Nunes, Hilario
A1 Plantier, Laurent
A1 Prevot, Grégoire
A1 Quetant, Sébastien
A1 Traclet, Julie
A1 Valentin, Victor
A1 Uzunhan, Yurdagul
A1 Wémeau-Stervinou, Lidwine
A1 Bejan-Angoulvant, Theodora
A1 Cottin, Vincent
A1 Marchand-Adam, Sylvain
A1 
YR 2023
UL http://erj.ersjournals.com/content/61/6/2202071.abstract
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