Rituximab induced pulmonary fibrosis in a patient with lupus nephritis

Targeted Therapy for Idiopathic Pulmonary Fibrosis: Where To Now?

Idiopathic pulmonary fibrosis (IPF) is an aging-associated, recalcitrant lung disease with historically limited therapeutic options. The recent approval of two drugs, pirfenidone and nintedanib, by the US Food and Drug Administration in 2014 has heralded a new era in its management. Both drugs have demonstrated efficacy in phase III clinical trials by retarding the rate of progression of IPF; neither drug appears to be able to completely arrest disease progression. Advances in the understanding of IPF pathobiology have led to an unprecedented expansion in the number of potential therapeutic targets. Drugs targeting several of these are under investigation in various stages of clinical development. Here, we provide a brief overview of the drugs that are currently approved and others in phase II clinical trials. Future therapeutic opportunities that target novel pathways, including some that are associated with the biology of aging, are examined. A multi-targeted approach, potentially with combination therapies, and identification of individual patients (or subsets of patients) who may respond more favourably to specific agents are likely to be more effective.

Increased levels of tumor necrosis factor-α involved in rituximab-related acute pulmonary fibrosis in diffuse large B-cell lymphoma

OBJECTIVES

Rituximab is a chimeric anti-CD20 monoclonal antibody with murine variable regions and human IgG1 constant regions that depletes B lymphocytes. It is used with increasing frequency in the treatment of patients with other hematologic malignancies and nonhematologic diseases for its safety and efficacy. Its major adverse effects are infusion related and most commonly consist of fever, chills, dyspnea, and hypotension. Rituximab-induced lung injury, such as interstitial pneumonitis and pulmonary fibrosis, is a rare complication but has been reported.

METHODS

We herein report a patient with diffuse large B-cell non-Hodgkin lymphoma who developed acute pulmonary fibrosis after treatment with rituximab.

RESULTS

Simultaneous tumor necrosis factor (TNF)-α levels were significantly increased. The patient had a dramatic recovery that was confirmed by a repeated computed tomography scan, and the levels of TNF-α returned to normal after 2 weeks of methylprednisolone treatment.

CONCLUSIONS

We observe that increased TNF-α levels may be involved in rituximab-related acute pulmonary fibrosis.