PT - JOURNAL ARTICLE AU - Rezaur Abdullah AU - Damien Ming AU - Gregory Keir AU - Toby Maher AU - Athol Wells AU - Elisabetta Renzoni TI - Rituximab in severe, treatment-refractory interstitial lung disease DP - 2013 Sep 01 TA - European Respiratory Journal PG - P5127 VI - 42 IP - Suppl 57 4099 - http://erj.ersjournals.com/content/42/Suppl_57/P5127.short 4100 - http://erj.ersjournals.com/content/42/Suppl_57/P5127.full SO - Eur Respir J2013 Sep 01; 42 AB - BackgroundIn a subgroup of patients with severe interstitial lung disease (ILD) progressing despite conventional immunosuppression, rituximab, a B cell-depleting monoclonal antibody, may offer an effective rescue therapy.MethodsRetrospective assessment of 50 patients with severe, progressive ILD (34 with connective tissue disease-associated ILD, 7 with fibrotic hypersensitivity pneumonitis, 3 with likely drug-induced ILD, the rest with miscellaneous ILD patterns, excluding idiopathic pulmonary fibrosis) treated with rituximab between 2010 and 2012. At the time of rituximab treatment, mean DLco was 25.5 % (±9.9%), and FVC was 49.1% (±17.6%). Change in pulmonary function tests compared to pre-rituximab levels, was assessed at six to twelve months post-treatment. Changes in lung function before and after treatment were analysed by Wilcoxon signed rank test.ResultsIn contrast with a median decline in forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLco) of 14.6% and 18.8% respectively in the six to twelve months prior to rituximab, analysis of paired pulmonary function data revealed a median improvement in FVC of 5.7% (p<0.01) and stability of DLco (p<0.01) in the six to twelve months following rituximab treatment. Two patients developed serious infections (pneumonia) requiring hospitalisation following rituximab, and ten patients died, all from progression of underlying ILD, a median of 5.1 months after treatment.ConclusionsIn a subgroup of patients with severe, progressive ILD unresponsive to conventional immunosuppression, rituximab may offer a safe and effective therapeutic intervention. Future prospective, controlled trials are warranted to validate these findings.