Re: RESEARCH - Clinical expression of Arava-induced pneumonitis

[Guest guest]

Yet another drug with lung related problems. Seems like most of these drugs for

RA have the rare lung issue in some way or another. I wonder why that is.

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> Rheumatology Advance Access published online on March 25, 2009

> Rheumatology, doi:10.1093/rheumatology/kep050

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> Clinical expression of leflunomide-induced pneumonitis

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> Batsi Chikura1, Lane2 and K Dawson3

> 1Royal Liverpool University Hospitals, 2Department of Biostatistics,

> Liverpool University, Liverpool and 3St Helens Hospital, St Helens,

> UK.

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> Abstract

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> Objectives. To review all the current evidence of LEF-induced

> pneumonitis (LEIP) which will help rheumatologists recognize suspected

> cases of LEIP and to influence clinical guidelines.

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> Methods. Thirty-two reported cases of LEIP (13 males and 19 females)

> were identified from a literature search and classified using Searles

> and McKendry's classification criteria. Their clinical characteristics

> were reviewed.

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> Results. All patients had a history of either exposure to MTX or

> interstitial lung disease (ILD) or both and all patients had RA. Most

> patients (82%) had LEIP within the first 20 weeks of initiation of

> LEF. All patients who had a loading dose LEF and most patients with

> ILD developed LEIP early (within 12 weeks of exposure). Case mortality

> was 19%. Two patients had previous MTX-induced pneumonitis (MTX-P)

> prior to initiation of LEF; both died from LEIP. There was a high

> mortality in the following groups of patients: diffuse alveolar damage

> (DAD) on histological examination, pre-existing ILD and ground glass

> shadowing on high resolution computerised tomography (HRCT). Treatment

> with cholestyramine did not appear to alter clinical outcome.

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> Conclusions. LEIP usually occurs within the first 20 weeks of

> initiation of LEF. Clinical features of patients who died were

> pre-existing ILD, ground glass shadowing on HRCT and DAD on

> histological examination, and these could be poor prognostic

> indicators. Patients need to be made aware of this rare complication.

> LEF should not be used in patients with previous MTX-P and should be

> used with caution in patients with ILD.

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> http://rheumatology.oxfordjournals.org/cgi/content/abstract/kep050v1?papetoc

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> Not an MD

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