Learnings from clinical trials in patients with connective tissue disease-associated interstitial lung disease

Arthritis Res Ther. 2023 Jul 8;25(1):118. doi: 10.1186/s13075-023-03090-y.

Abstract

Many clinical trial results are available to inform best practices in the treatment of patients with connective tissue disease-associated interstitial lung disease (CTD-ILD).Herein, we summarize the results of clinical trials, including patient-reported outcome instruments, for the treatment of patients with ILD associated with systemic sclerosis (SSc/scleroderma), rheumatoid arthritis, and idiopathic inflammatory myositis, the diseases with the most available data. For SSc-ILD, the US Food and Drug Administration approved nintedanib (a tyrosine kinase inhibitor) in 2020 and subcutaneous tocilizumab (an IL-6 receptor monoclonal antibody) in 2021. Rituximab was recently shown to have similar efficacy but better tolerability than intravenous cyclophosphamide (CYC) for CTD-ILD therapy. Scleroderma Lung Study II, conducted in patients with SSc-ILD, showed that oral CYC and mycophenolate mofetil (MMF) were comparable in their effects on lung function, but MMF was better tolerated. The increasing treatment armamentarium for patients with CTD-ILD offers physicians new opportunities to improve patient outcomes.

Keywords: Connective tissue disease; Fibrotic lung disease; Inflammatory lung disease; Interstitial lung disease; Nintedanib; Pirfenidone; Rituximab; Scleroderma; Systemic sclerosis; Tocilizumab.

Publication types

  • Review
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Connective Tissue Diseases* / complications
  • Connective Tissue Diseases* / drug therapy
  • Cyclophosphamide / therapeutic use
  • Humans
  • Immunosuppressive Agents / pharmacology
  • Immunosuppressive Agents / therapeutic use
  • Lung
  • Lung Diseases, Interstitial* / complications
  • Lung Diseases, Interstitial* / etiology
  • Mycophenolic Acid / pharmacology
  • Mycophenolic Acid / therapeutic use
  • Scleroderma, Localized*
  • Scleroderma, Systemic* / complications
  • Scleroderma, Systemic* / drug therapy

Substances

  • Immunosuppressive Agents
  • Cyclophosphamide
  • Mycophenolic Acid