Systemic corticosteroid treatment response in hypersensitivity pneumonitis: a single center experience
Öz
Aim: Hypersensitivity pneumonitis (HP) is defined as an inflammatory and/or fibrotic immune reaction provoked by an inhalational exposure in susceptible individuals. Initial management of HP patients includes remediation of exposure and treatment with immunosuppressive agents. In this study we aimed to define clinical features and treatment modalities and to evaluate response to corticosteroids in HP patients followed in a single tertiary care setting.
Materials and Methods: The patients with HP diagnosis followed between 1 January 2019 and 31 December 2020 were included in this retrospective study. Firstly, the candidate factors related with treatment response were evaluated by univariate analysis and then the possible factors with p values below 0.15 were evaluated by multiple linear regression model to identify independent predictors of systemic corticosteroid response.
Results: The study population consisted of 50 HP patients and 20 of them (40%) had fibrotic HP. Forty-one (82.0%) patients were followed with a medical treatment for longer than 3 months. Within follow-up period 15 (36.5%) patients didn’t show clinical or radiological response to systemic corticosteroids. Patients without treatment response were presented as fibrotic HP (66.6% vs 26%, p=0.02), had radiological features of fibrosis (86.6% vs 30.7%, p=0.002) and had loss of pulmonary functions (60.0% vs 34.6%, p=0.03) more frequently. Uni-variable analysis revealed that radiological features of fibrosis (OR: 0.07 [95%CI: 0.01-0.42], p=0.003) and mosaic attenuation (OR: 7.0 [95%CI: 0.30-10.07], p=0.08) in HRCT related with corticosteroid treatment response.
Conclusion: Our study suggests radiological features of fibrosis relate with worse clinical and radiological response to corticosteroid treatment. Prospective clinical trials are needed to clarify the role of immunosuppressive therapy in HP patients.
Anahtar Kelimeler
Hypersensitivity pneumonitis immunosuppressive treatment corticosteroid treatment response.
Kaynakça
- Raghu G, Remy-Jardin M, Ryerson CJ, et al. Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med. 2020;202(3):e36-e69. doi: 10.1164/rccm.202005-2032ST
- Barnes H, Troy L, Lee CT, Sperling A, Strek M, Glaspole I. Hypersensitivity pneumonitis: Current concepts in pathogenesis, diagnosis, and treatment. Allergy. 2021 Jul 22. doi: 10.1111/all.15017.
- Costabel U, Miyazaki Y, Pardo A, et al. Hypersensitivity pneumonitis. Nat Rev Dis Primers. 2020; 6 (1): 65. doi: 10.1038/s41572-020-0191-z.
- Flaherty KR, Wells AU, Cottin V, et al. INBUILD Trial Investigators. Nintedanib in Progressive Fibrosing Interstitial Lung Diseases. N Engl J Med. 2019; 381 (18): 1718-27. doi: 10.1056/NEJMoa1908681
- Salisbury ML, Myers JL, Belloli EA, Kazerooni EA, Martinez FJ, Flaherty KR. Diagnosis and Treatment of Fibrotic Hypersensitivity Pneumonia. Where We Stand and Where We Need to Go. Am J Respir Crit Care Med. 2017; 196 (6): 690-9. doi: 10.1164/rccm.201608-1675PP.
- Ejima M, Okamoto T, Suzuki T, Anzai T, Takahashi K, Miyazaki Y. Efficacy of treatment with corticosteroids for fibrotic hypersensitivity pneumonitis: a propensity score-matched cohort analysis. BMC Pulm Med. 2021; 21 (1): 243. doi: 10.1186/s12890-021-01608-1.
- De Sadeleer LJ, Hermans F, De Dycker E, et al. Impact of BAL lymphocytosis and presence of honeycombing on corticosteroid treatment effect in fibrotic hypersensitivity pneumonitis: a retrospective cohort study. Eur Respir J. 2020; 55 (4): 1901983. doi: 10.1183/13993003.01983-2019.
- Tony FA, Soliman YMA, Salem HA. Effect of Oral Methyl Prednisolone on Different Radiological Patterns of Hypersensitivity Pneumonitis. J Asthma Allergy. 2021;14: 501-11. doi: 10.2147/JAA.S299939.
- Adegunsoye A, Oldham JM, Fernández Pérez ER, et al. Outcomes of immunosuppressive therapy in chronic hypersensitivity pneumonitis. ERJ Open Res. 2017; 3 (3): 00016-2017. doi: 10.1183/23120541.00016-2017.
- Idiopathic Pulmonary Fibrosis Clinical Research Network Randomized trial of acetylcysteine in idiopathic pulmonary fibrosis. N Engl J Med 2014; 370: 2093–101.
- Idiopathic Pulmonary Fibrosis Clinical Research N Prednisone, azathioprine, and N-acetylcysteine for pulmonary fibrosis. N Engl J Med 2012; 366: 1968–77.
- Salisbury ML, Gu T, Murray S, et al. Hypersensitivity Pneumonitis: Radiologic Phenotypes Are Associated With Distinct Survival Time and Pulmonary Function Trajectory. Chest. 2019; 155 (4): 699-711. doi: 10.1016/j.chest.2018.08.1076.
- Morisset J, Johannson KA, Vittinghoff E, et al. Use of Mycophenolate Mofetil or Azathioprine for the Management of Chronic Hypersensitivity Pneumonitis. Chest. 2017; 151 (3): 619-25. doi: 10.1016/j.chest.2016.10.029.
- Fiddler CA, Simler N, Thillai M, Parfrey H. Use of mycophenolate mofetil and azathioprine for the treatment of chronic hypersensitivity pneumonitis-A single-centre experience. Clin Respir J. 2019; 13 (12): 791-4. doi: 10.1111/crj.13086.
- Raimundo S, Pimenta AC, Cruz-Martins N, et al. Insights on chronic hypersensitivity pneumonitis' treatment: Factors associated with a favourable response to azathioprine. Life Sci. 2021;272:119274. doi: 10.1016/j.lfs.2021.119274.
- Ferreira M, Borie R, Crestani B, et al.Efficacy and safety of rituximab in patients with chronic hypersensitivity pneumonitis (cHP): A retrospective, multicentric, observational study. Respir Med. 2020; 172: 106146. doi: 10.1016/j.rmed.2020.106146
Hipersensitivite pnömonisi hastalarında sistemik kortikosteroid tedavi yanıtı: bir tek merkez deneyimi
Öz
Amaç: Hipersensitivite pnömonisi (HP) duyarlı bireylerde, inhalasyon yolu ile gelen maruziyetlere karşı gelişen inflamatuar ve/veya fibrotik bir immün yanıt olarak tanımlanmaktadır. HP hastalarının yönetimi maruziyetten kaçınmak ve immunsupresif ajanlarla tedaviyi içermektedir. Çalışmamızda bir üniversite hastanesinde takip edilen HP hastalarının klinik özelliklerini ve kortikosteroid tedaviye yanıtlarını değerlendirmeyi amaçladık.
Gereç ve Yöntem: HP tanısı ile 1 Ocak 2019 ve 31 Aralık 2020 tarihleri arasında takip edilen hastalar
retrospektif olarak çalışmaya dahil edildi. Tedavi yanıtı ile olasılıkla ilişkili faktörler öncelikte tek
değişkenli olarak değerlendirildi. Sonrasında p değeri 0,15 ve altında olan faktörler çok değişkenli
lineer regresyon modeli ile değerlendirilerek sistemik kortikosteroid yanıtı ile bağımsız ilişkili olan
faktörler tanımlandı.
Bulgular: Çalışmamıza dahil edilen 50 HP hastasının 20 (%40,0)’ı fibrotik HP idi. Kırk bir (%82,0)
hasta en az 3 aydır medikal tedavi almaktaydı. Takip süresince 15 (%36,5) hasta sistemik
kortikosteroid tedavisine klinik veya radyolojik yanıt göstermedi. Tedavi yanıtı izlenmeyen olgular,
sıklıkla fibrotik HP ile prezente olmakta (66,6% vs 26,0%, p=0,02), radyolojik olarak fibrozis bulguları
göstermekte (%86,6 karşı %30,7, p=0,002) ve takiplerinde solunum fonksiyonlarında kaybı (%60,0
karşı %34,6, p=0,03) daha sık yaşamaktaydı. Tek değişkenli analizlerde radyolojik bulgulardan fibrozis
varlığı (OR: 0,07 [95%CI: 0,01-0,42], p=0,003) ve mozaik atenüasyon bulgusu (OR: 7,0 [95%CI: 0,30-
10,07], p=0,08) kortikositeroid tedavi yanıtı ile ilişkili bulundu.
Sonuç: Çalışmamız radyolojik olarak fibrozis bulgusunun varlığının kortikosteroid tedaviye kötü klinik
ve radyolojik yanıt ile ilişkili olduğunu önermektedir. HP hastalarında immunsupresif tedavinin rolünün
belirlenmesi için prospektif klinik çalışmalara ihtiyaç duyulmaktadır.
Anahtar Kelimeler
Hipersensitivite pnömonisi immunsupresif tedavi kortikosteroid tedavi yanıtı.
Kaynakça
- Raghu G, Remy-Jardin M, Ryerson CJ, et al. Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med. 2020;202(3):e36-e69. doi: 10.1164/rccm.202005-2032ST
- Barnes H, Troy L, Lee CT, Sperling A, Strek M, Glaspole I. Hypersensitivity pneumonitis: Current concepts in pathogenesis, diagnosis, and treatment. Allergy. 2021 Jul 22. doi: 10.1111/all.15017.
- Costabel U, Miyazaki Y, Pardo A, et al. Hypersensitivity pneumonitis. Nat Rev Dis Primers. 2020; 6 (1): 65. doi: 10.1038/s41572-020-0191-z.
- Flaherty KR, Wells AU, Cottin V, et al. INBUILD Trial Investigators. Nintedanib in Progressive Fibrosing Interstitial Lung Diseases. N Engl J Med. 2019; 381 (18): 1718-27. doi: 10.1056/NEJMoa1908681
- Salisbury ML, Myers JL, Belloli EA, Kazerooni EA, Martinez FJ, Flaherty KR. Diagnosis and Treatment of Fibrotic Hypersensitivity Pneumonia. Where We Stand and Where We Need to Go. Am J Respir Crit Care Med. 2017; 196 (6): 690-9. doi: 10.1164/rccm.201608-1675PP.
- Ejima M, Okamoto T, Suzuki T, Anzai T, Takahashi K, Miyazaki Y. Efficacy of treatment with corticosteroids for fibrotic hypersensitivity pneumonitis: a propensity score-matched cohort analysis. BMC Pulm Med. 2021; 21 (1): 243. doi: 10.1186/s12890-021-01608-1.
- De Sadeleer LJ, Hermans F, De Dycker E, et al. Impact of BAL lymphocytosis and presence of honeycombing on corticosteroid treatment effect in fibrotic hypersensitivity pneumonitis: a retrospective cohort study. Eur Respir J. 2020; 55 (4): 1901983. doi: 10.1183/13993003.01983-2019.
- Tony FA, Soliman YMA, Salem HA. Effect of Oral Methyl Prednisolone on Different Radiological Patterns of Hypersensitivity Pneumonitis. J Asthma Allergy. 2021;14: 501-11. doi: 10.2147/JAA.S299939.
- Adegunsoye A, Oldham JM, Fernández Pérez ER, et al. Outcomes of immunosuppressive therapy in chronic hypersensitivity pneumonitis. ERJ Open Res. 2017; 3 (3): 00016-2017. doi: 10.1183/23120541.00016-2017.
- Idiopathic Pulmonary Fibrosis Clinical Research Network Randomized trial of acetylcysteine in idiopathic pulmonary fibrosis. N Engl J Med 2014; 370: 2093–101.
- Idiopathic Pulmonary Fibrosis Clinical Research N Prednisone, azathioprine, and N-acetylcysteine for pulmonary fibrosis. N Engl J Med 2012; 366: 1968–77.
- Salisbury ML, Gu T, Murray S, et al. Hypersensitivity Pneumonitis: Radiologic Phenotypes Are Associated With Distinct Survival Time and Pulmonary Function Trajectory. Chest. 2019; 155 (4): 699-711. doi: 10.1016/j.chest.2018.08.1076.
- Morisset J, Johannson KA, Vittinghoff E, et al. Use of Mycophenolate Mofetil or Azathioprine for the Management of Chronic Hypersensitivity Pneumonitis. Chest. 2017; 151 (3): 619-25. doi: 10.1016/j.chest.2016.10.029.
- Fiddler CA, Simler N, Thillai M, Parfrey H. Use of mycophenolate mofetil and azathioprine for the treatment of chronic hypersensitivity pneumonitis-A single-centre experience. Clin Respir J. 2019; 13 (12): 791-4. doi: 10.1111/crj.13086.
- Raimundo S, Pimenta AC, Cruz-Martins N, et al. Insights on chronic hypersensitivity pneumonitis' treatment: Factors associated with a favourable response to azathioprine. Life Sci. 2021;272:119274. doi: 10.1016/j.lfs.2021.119274.
- Ferreira M, Borie R, Crestani B, et al.Efficacy and safety of rituximab in patients with chronic hypersensitivity pneumonitis (cHP): A retrospective, multicentric, observational study. Respir Med. 2020; 172: 106146. doi: 10.1016/j.rmed.2020.106146
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Aralık 2022 |
| Gönderilme Tarihi | 3 Şubat 2022 |
| Yayımlandığı Sayı | Yıl 2022 |