Julie Morisset1, Kerri A Johannson2, Eric Vittinghoff3, Carlos Aravena4, Brett M Elicker5, Kirk D Jones6, Charlene D Fell2, Helene Manganas7, Bruno-Pierre Dubé7, Paul J Wolters8, Harold R Collard8, Christopher J Ryerson9, Brett Ley8. 1. Department of Medicine, University of California, San Francisco, San Francisco, CA; Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada. Electronic address: julie.morisset@umontreal.ca. 2. Department of Medicine, University of Calgary, Calgary, AB, Canada. 3. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA. 4. Department of Respiratory Diseases, Pontifical Catholic University of Chile, Santiago, Chile. 5. Department of Radiology, University of California, San Francisco, San Francisco, CA. 6. Department of Pathology, University of California, San Francisco, San Francisco, CA. 7. Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada. 8. Department of Medicine, University of California, San Francisco, San Francisco, CA. 9. Department of Medicine and Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada.
Abstract
BACKGROUND: The treatment of chronic hypersensitivity pneumonitis (cHP) often includes systemic oral corticosteroids, but the optimal pharmacologic management remains unclear. The morbidity associated with prednisone has motivated the search for alternative therapies. We aimed to determine the effect of treatment with mycophenolate mofetil (MMF) or azathioprine (AZA) on lung function in patients with cHP. METHODS: Patients with cHP treated with either MMF or AZA were retrospectively identified from four interstitial lung disease centers. Change in lung function before and after treatment initiation was analyzed using linear mixed-effects modeling (LMM), adjusting for age, sex, smoking history, and prednisone use. RESULTS: Seventy patients were included: 51 were treated with MMF and 19 with AZA. Median follow-up after treatment initiation was 11 months. Prior to treatment initiation, FVC and diffusion capacity of the lung for carbon monoxide (Dlco) % predicted were declining at a mean rate of 0.12% (P < .001) and 0.10% (P < .001) per month, respectively. Treatment with either MMF or AZA was not associated with improved FVC (0.5% at 1 year; P = .46) but was associated with a statistically significant improvement in Dlco of 4.2% (P < .001) after 1 year of treatment. Results were similar in the subgroup of patients treated with MMF for 1 year; the FVC increased nonsignificantly by 1.3% (P = .103) and Dlco increased by 3.9% (P < .001). CONCLUSIONS: Treatment with MMF or AZA is associated with improvements in Dlco in patients with cHP. Prospective randomized trials are needed to validate their effectiveness for cHP.
BACKGROUND: The treatment of chronic hypersensitivitypneumonitis (cHP) often includes systemic oral corticosteroids, but the optimal pharmacologic management remains unclear. The morbidity associated with prednisone has motivated the search for alternative therapies. We aimed to determine the effect of treatment with mycophenolate mofetil (MMF) or azathioprine (AZA) on lung function in patients with cHP. METHODS:Patients with cHP treated with either MMF or AZA were retrospectively identified from four interstitial lung disease centers. Change in lung function before and after treatment initiation was analyzed using linear mixed-effects modeling (LMM), adjusting for age, sex, smoking history, and prednisone use. RESULTS: Seventy patients were included: 51 were treated with MMF and 19 with AZA. Median follow-up after treatment initiation was 11 months. Prior to treatment initiation, FVC and diffusion capacity of the lung for carbon monoxide (Dlco) % predicted were declining at a mean rate of 0.12% (P < .001) and 0.10% (P < .001) per month, respectively. Treatment with either MMF or AZA was not associated with improved FVC (0.5% at 1 year; P = .46) but was associated with a statistically significant improvement in Dlco of 4.2% (P < .001) after 1 year of treatment. Results were similar in the subgroup of patients treated with MMF for 1 year; the FVC increased nonsignificantly by 1.3% (P = .103) and Dlco increased by 3.9% (P < .001). CONCLUSIONS: Treatment with MMF or AZA is associated with improvements in Dlco in patients with cHP. Prospective randomized trials are needed to validate their effectiveness for cHP.
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