Sjögren Syndrome With Associated Lymphocytic Interstitial Pneumonia Successfully Treated With Tacrolimus and Abatacept as an Alternative to Rituximab

Grace Thompson; Andrew Mclean-Tooke; Jeremy Wrobel; Melanie Lavender; Michaela Lucas

doi:10.1016/j.chest.2017.12.010

Sjögren Syndrome With Associated Lymphocytic Interstitial Pneumonia Successfully Treated With Tacrolimus and Abatacept as an Alternative to Rituximab

Chest. 2018 Mar;153(3):e41-e43. doi: 10.1016/j.chest.2017.12.010.

Authors

Grace Thompson¹, Andrew Mclean-Tooke², Jeremy Wrobel³, Melanie Lavender⁴, Michaela Lucas⁵

Affiliations

¹ Department of Immunology, Sir Charles Gairdner Hospital and Pathwest, Nedlands, WA, Australia. Electronic address: [email protected].
² Department of Immunology, Sir Charles Gairdner Hospital and Pathwest, Nedlands, WA, Australia.
³ Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia; Department of Medicine, University of Notre Dame, Fremantle, WA, Australia.
⁴ Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia.
⁵ Department of Immunology, Sir Charles Gairdner Hospital and Pathwest, Nedlands, WA, Australia; School of Medicine and Pharmacology, School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, Australia.

PMID: 29519308
DOI: 10.1016/j.chest.2017.12.010

Abstract

Interstitial lung disease (ILD) is a significant complication of Sjögren syndrome (SS) associated with increased morbidity and mortality. The mainstay of treatment remains corticosteroid administration, with or without additional immunosuppressive therapies. Preliminary studies in SS have shown benefit in glandular and serologic parameters following treatment with the CTLA4 immunoglobulin fusion protein abatacept. Topical tacrolimus has been effective for ocular symptoms in SS, but systemic therapy has not been reported. We describe the first case, to our knowledge, of the successful use of a combination of systemic tacrolimus and abatacept in severe refractory SS and related ILD.

Keywords: Sjögren syndrome; abatacept; interstitial lung disease; tacrolimus.

Publication types

Case Reports

MeSH terms

Abatacept / therapeutic use*
Female
Humans
Immunosuppressive Agents / adverse effects
Immunosuppressive Agents / therapeutic use*
Lung Diseases, Interstitial / drug therapy*
Middle Aged
Respiratory Function Tests
Rituximab / adverse effects
Sjogren's Syndrome / drug therapy*
Tacrolimus / therapeutic use*

Substances

Immunosuppressive Agents
Rituximab
Abatacept
Tacrolimus

Supplementary concepts

Lymphoid Interstitial Pneumonia