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Long-Term Treatment With Azathioprine and Mycophenolate Mofetil for Myositis-Related Interstitial Lung Disease.
- Source :
-
Chest [Chest] 2019 Nov; Vol. 156 (5), pp. 896-906. Date of Electronic Publication: 2019 Jun 22. - Publication Year :
- 2019
-
Abstract
- Background: The efficacy of azathioprine (AZA) and mycophenolate mofetil (MMF) for interstitial lung disease (ILD) has been described, but mainly in connective tissue disease-associated ILD. The objective of this study was to evaluate the effect of AZA and MMF on lung function and prednisone dose in myositis-related ILD (M-ILD).<br />Methods: In this retrospective study, patients with M-ILD seen at Johns Hopkins and treated with AZA or MMF and no other steroid-sparing agents were included. Linear mixed-effects models adjusted for sex, age, antisynthetase antibody, and smoking status were used to compare the change in FVC % predicted, diffusing capacity of the lungs for carbon monoxide (Dlco) % predicted, and prednisone dose.<br />Results: Sixty-six patients with M-ILD were treated with AZA and 44 with MMF. At treatment initiation, mean FVC % predicted and Dlco % predicted were significantly lower in the AZA group than in the MMF group. In both groups, FVC % predicted improved and the prednisone dose was reduced over 2 to 5 years; however, for Dlco % predicted, only the AZA group improved. The adjusted model showed no significant difference in posttreatment FVC % predicted or Dlco % predicted between groups (mean difference of 1.9 and -8.2, respectively), but a 6.6-mg lower dose of prednisone at 36 months in the AZA group. Adverse events were more frequent with AZA than MMF (33.3% vs 13.6%; P = .04).<br />Conclusions: In M-ILD, AZA treatment was associated with improved FVC % predicted and Dlco % predicted, and lower prednisone dose. Patients treated with MMF had improved FVC % predicted and lower prednisone dose. After 36 months, patients treated with AZA received a lower prednisone dose than those treated with MMF.<br /> (Copyright © 2019 American College of Chest Physicians. All rights reserved.)
- Subjects :
- Enzyme Inhibitors therapeutic use
Female
Follow-Up Studies
Glucocorticoids therapeutic use
Humans
Immunosuppressive Agents therapeutic use
Lung diagnostic imaging
Lung physiopathology
Lung Diseases, Interstitial etiology
Lung Diseases, Interstitial physiopathology
Male
Middle Aged
Myositis drug therapy
Prednisone therapeutic use
Respiratory Function Tests
Retrospective Studies
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Azathioprine therapeutic use
Forced Expiratory Volume physiology
Lung Diseases, Interstitial drug therapy
Mycophenolic Acid therapeutic use
Myositis complications
Subjects
Details
- Language :
- English
- ISSN :
- 1931-3543
- Volume :
- 156
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Chest
- Publication Type :
- Academic Journal
- Accession number :
- 31238042
- Full Text :
- https://doi.org/10.1016/j.chest.2019.05.023