Tacrolimus-induced pulmonary injury in rheumatoid arthritis patients - 02/08/11
, Michi Tanaka a, Yukiko Komano a, Fumikazu Sakai b, Haruhito Sugiyama c, Toshihiro Nanki a, Hiroshi Ide d, Satoshi Jodo e, Kou Katayama f, Hidekazu Matsushima g, Yusuke Miwa h, Koichi Morita i, Hiroshi Nakashima j, Hiroyuki Nakamura k, Masamitsu Natsumeda l, Yoshiko Sato m, Seitaro Semba k, Mutsuto Tateishi n, Nobuyuki Miyasaka a, Masayoshi Harigai a
Corresponding author. Department of Pharmacovigilance, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. Tel.: +81 3 5803 4677; fax: +81 3 5803 4694.Abstract |
Background |
Tacrolimus (TAC) was approved in Japan in 2005 for rheumatoid arthritis (RA) patients having inadequate response to other disease-modifying anti-rheumatic drugs. As of May 2007, spontaneous reports identified twenty-seven cases of exacerbation or new development of interstitial pneumonia among RA patients given TAC in Japan.
Objective |
To describe the clinical and radiological characteristics of TAC-induced pulmonary injury (TIPI).
Patients and methods |
Eleven RA patients diagnosed with de novo pulmonary injury or exacerbation of IP during treatment with TAC were identified. Clinical, radiological, and laboratory data of ten of these cases were retrospectively analyzed.
Results |
Baseline data for the ten patients were a mean age of 69.7 years; gender, 70% female; mean RA disease duration, 9.1 years; and pulmonary comorbidities, 90%. Six cases were classified as presumptive TAC-induced pulmonary injury (TIPI) and four as probable TIPI. Among the six presumptive cases, TIPI developed at an average of 84 days after initiation of treatment (n = 5) or four days after reinstitution of TAC (n = 1). Five cases were an exacerbation of pre-existing interstitial pneumonia and one was a de novo pulmonary injury. Radiological patterns of thoracic computed tomography (CT) scans of patients in the presumptive TIPI cases were hypersensitivity pneumonia like-pattern (n = 3), ground-glass opacity (n = 2), and organizing pneumonia-pattern (n = 1). All patients with presumptive TIPI were treated with high dosage glucocorticosteroids and one received concomitant immunosuppressants. Two of the six presumptive TIPI patients died.
Conclusion |
Rheumatologists should be aware of this rare but potentially life-threatening adverse event in RA patients receiving TAC.
Le texte complet de cet article est disponible en PDF.Keywords : Tacrolimus
MeSH : Lung injury, Lung disease, Drug toxicity arthritis
Abbreviations : TAC, RA, DMARD, TIPI, CT, CRP
Plan
Vol 24 - N° 4
P. 401-406 - août 2011 Retour au numéro
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