RESEARCH - Clinical expression of Arava-induced pneumonitis

[Guest guest]

Rheumatology Advance Access published online on March 25, 2009

Rheumatology, doi:10.1093/rheumatology/kep050

Clinical expression of leflunomide-induced pneumonitis

Batsi Chikura1, Lane2 and K Dawson3

1Royal Liverpool University Hospitals, 2Department of Biostatistics,

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

UK.

Abstract

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.

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.

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.

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.

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

Not an MD