Interstitial lung disease (ILD) can arise in a variety of connective tissue diseases (CTDs) and various treatment interventions are being explored. In 2020, advances in the treatment of CTD-associated ILD have included the re-evaluation of methotrexate-induced lung injury and emerging insights on anti-IL-6 therapy and anti-fibrotic therapy in this condition.
Key advances
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Methotrexate use is probably not a notable cause of chronic fibrotic lung disease in rheumatoid arthritis (RA), and this drug might even delay the presentation of interstitial lung disease (ILD)1.
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The efficacy of the anti-fibrotic agent nintedanib in the treatment of progressive fibrosing ILDs extends to the treatment of progressive connective tissue disease-associated ILD2.
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Anti-IL-6 therapy is emerging as a potential new treatment option for systemic sclerosis-associated ILD3.
References
Juge, P. A. et al. Methotrexate and rheumatoid arthritis associated interstitial lung disease. Eur. Respir. J. 2000337 (2020).
Wells, A. U. et al. Nintedanib in patients with progressive fibrosing interstitial lung diseases-subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial. Lancet Respir. Med. 8, 453–460 (2020).
Khanna, D. et al. Tocilizumab in systemic sclerosis: a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Respir. Med. 8, 963–974 (2020).
Rojas-Serrano, J. et al. Rheumatoid arthritis-related interstitial lung disease (RA-ILD): methotrexate and the severity of lung disease are associated to prognosis. Clin. Rheumatol. 36, 1493–1500 (2017).
Robles-Pérez, A. et al. A prospective study of lung disease in a cohort of early rheumatoid arthritis patients. Sci. Rep. 10, 15640 (2020).
Ibfelt, E. H. et al. Methotrexate and risk of interstitial lung disease and respiratory failure in rheumatoid arthritis: a nationwide population-based study. Rheumatology (Oxford) 11, keaa327 (2020).
Li, L. et al. A retrospective study on the predictive implications of clinical characteristics and therapeutic management in patients with rheumatoid arthritis-associated interstitial lung disease. Clin. Rheumatol. 39, 1457–1470 (2020).
Flaherty, K. R. et al. Nintedanib in progressive fibrosing interstitial lung diseases. N. Engl. J. Med. 381, 1718–1727 (2019).
Distler, O. et al. Nintedanib for systemic sclerosis-associated interstitial lung disease. N. Engl. J. Med. 380, 2518–2528 (2019).
Khanna, D. et al. Safety and efficacy of subcutaneous tocilizumab in systemic sclerosis: results from the open-label period of a phase II randomised controlled trial (faSScinate). Ann. Rheum. Dis. 77, 212–220 (2018).
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A.U.W. declares that he has received speaker fees and consulting honouraria from Boehringer Ingelheim and Roche.
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Wells, A.U. New insights into the treatment of CTD-ILD. Nat Rev Rheumatol 17, 79–80 (2021). https://doi.org/10.1038/s41584-020-00567-x
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DOI: https://doi.org/10.1038/s41584-020-00567-x
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