Department of Autoimmune Diseases, Laboratory of Autoimmune Diseases Josep Font, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Spain.
Am J Med. 2011 May;124(5):386-94. doi: 10.1016/j.amjmed.2010.11.028.
Monoclonal antibodies have emerged as a new class of agents causing drug-related pulmonary involvement in patients with systemic rheumatologic autoimmune diseases. The most frequently associated noninfectious pulmonary diseases are interstitial pneumonia (118 cases reported by August 2010), sarcoid-like disease and vasculitis (40 cases), and 97% of cases are associated with agents blocking tumor necrosis factor (TNF), a cytokine implicated in pulmonary fibrosis, granuloma formation, and maintenance. Drug-induced interstitial pneumonia has a poor prognosis, with an overall mortality rate of around one-third, rising to two-thirds in patients with pre-existing interstitial disease. Sarcoid-like disease has a better prognosis, with resolution or improvement in 90% of cases. Although the evidence comes overwhelmingly from case reports and case series, suggested recommendations for patient management include a detailed pre-therapeutic evaluation, early identification of symptoms suggestive of pulmonary disease, and tailored therapy. Mycobacterial infection should be exhaustively investigated, especially after anti-TNF administration. Large, prospective, postmarketing studies including nonbiological agents as controls may help elucidate the real risk of pulmonary disease in patients with rheumatologic autoimmune diseases receiving monoclonal antibodies.
单克隆抗体已成为一类新的药物，可导致系统性风湿性自身免疫性疾病患者发生药物相关性肺损害。最常与非感染性肺病相关的疾病为间质性肺炎（截至 2010 年 8 月报告了 118 例）、类肉瘤样疾病和血管炎（40 例），并且 97%的病例与阻断肿瘤坏死因子（TNF）的药物相关，TNF 是一种细胞因子，与肺纤维化、肉芽肿形成和维持有关。药物性间质性肺炎预后较差，总体死亡率约为三分之一，在有预先存在的间质性疾病的患者中上升至三分之二。类肉瘤样疾病的预后较好，90%的病例得到缓解或改善。尽管证据主要来自病例报告和病例系列，但对患者管理的建议包括详细的治疗前评估、早期识别提示肺部疾病的症状以及针对性治疗。应彻底调查分枝杆菌感染，尤其是在使用抗 TNF 治疗后。包括非生物制剂作为对照的大型、前瞻性上市后研究可能有助于阐明接受单克隆抗体治疗的风湿性自身免疫性疾病患者发生肺部疾病的真实风险。
