Open-Label, Pilot Study of the Safety and Clinical Effects of Rituximab in Patients with Rheumatoid Arthritis-Associated Interstitial Pneumonia

Eric L. Matteson, Tim Bongartz, Jay H. Ryu, Cynthia S. Crowson, Thomas E. Hartman, Paul F. Dellaripa

Department of Health Sciences Research.
Department of Radiology, Mayo Clinic College of Medicine, Rochester , US.
Division of Pulmonary and Critical Care Medicine.
Division of Rheumatology, Brigham and Womens Hospital, Boston, US.
Division of Rheumatology, Milano, Italy.

DOI: 10.4236/ojra.2012.23011                

Abstract

Objective: To investigate the clinical effect of rituximab (RTX) in the management of progressive rheumatoid arthritis related interstitial lung disease (RA-ILD). Methods: A total of 10 patients with progressive RA-ILD were enrolled into this 48-week, open-label treatment study. Treatment was with RTX at 1000 mg at day 1, day 15, and again at weeks 24 and 26, with concomitant methotrexate therapy. Results: The study included 4 men and 6 women. Of 7 evaluable patients at week 48, the diffusing capacity to carbon monoxide had worsened by at least 15% in 1 patient, was stable in 4 patients, and increased by >15% of baseline value in 2 patients. The forced vital capacity declined by at least 10% in 1 patient, was stable in 4 patients, and increased by at least 10% in 2 patients. High resolution computed tomo-graphy of the chest showed improvement in 1 patient, and was unchanged in 5. Three patients were withdrawn, one who had an infusion reaction at week 0, one at week 5 who was hospitalized for congestive heart failure at week 5 and who later died at week 32 of complications following a traumatic hip fracture, and one died at week 6 of possible pneumonia. Conclusions: In this pilot study of 10 patients with RA-ILD treated with RTX, measures of lung disease remained stable in the majority of study completers. Further research is needed to clarify whether this treatment has a role in management of RA-ILD.

Keywords

Rheumatoid Arthritis; Interstitial Pneumonitis; Rituximab

Conflicts of Interest

The authors declare no conflicts of interest.

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