Abstract
Background Azathioprine is a commonly prescribed therapy for connective tissue disease-associated interstitial lung disease (CTD-ILD). Combination therapy that included azathioprine was recently shown to increase the risk of death and hospitalization in patients with idiopathic pulmonary fibrosis. Whether azathioprine increases the risk of adverse outcomes in patients with fibrotic CTD-ILD, including those with CTD-associated usual interstitial pneumonia (UIP), remains unknown. Methods A retrospective cohort analysis was performed to determine the combined incidence rate of death, transplant and respiratory hospitalization associated with azathioprine exposure. A fibrotic CTD-ILD cohort treated with mycophenolate mofetil served as a comparator group. Incidence rates were compared with an incidence rate ratio (IRR) generated by negative binomial regression. Longitudinal pulmonary function response was then assessed using mixed effects linear regression models. Results Fifty-four patients were treated with azathioprine and forty-three with mycophenolate. Medication discontinuation due to non-respiratory side effects occurred in 27% and 5% of the azathioprine and mycophenolate cohorts, respectively. The combined incidence rate of adverse outcomes was 0.015 and 0.013 for azathioprine and mycophenolate, respectively (IRR 1.23; 95% CI 0.49-3.12; p = 0.66). Similar incidence rates were observed among those with CTD-UIP (IRR 0.83; 95% CI 0.21-3.31; p = 0.79). Both groups demonstrated pulmonary function stability over time, with the azathioprine group demonstrating a marginal improvement. Conclusions A significant minority of patients could not tolerate azathioprine due to non-respiratory side effects. Of those who did tolerate azathioprine, a similar incidence of adverse outcomes was observed as those treated with mycophenolate. Both therapies were associated with stability in pulmonary function.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 117-122 |
| Number of pages | 6 |
| Journal | Respiratory Medicine |
| Volume | 121 |
| DOIs | |
| State | Published - Dec 1 2016 |
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Keywords
- Connective tissue disease
- Idiopathic pulmonary fibrosis
- Interstitial lung disease
- Mycophenolate mofetil
- Rheumatology
- Usual interstitial pneumonia
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
Cite this
Azathioprine response in patients with fibrotic connective tissue disease-associated interstitial lung disease. / Oldham, Justin; Lee, Cathryn; Valenzi, Eleanor; Witt, Leah J.; Adegunsoye, Ayodeji; Hsu, Scully; Chen, Lena; Montner, Steven; Chung, Jonathan H.; Noth, Imre; Vij, Rekha; Strek, Mary E.
In: Respiratory Medicine, Vol. 121, 01.12.2016, p. 117-122.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Azathioprine response in patients with fibrotic connective tissue disease-associated interstitial lung disease
AU - Oldham, Justin
AU - Lee, Cathryn
AU - Valenzi, Eleanor
AU - Witt, Leah J.
AU - Adegunsoye, Ayodeji
AU - Hsu, Scully
AU - Chen, Lena
AU - Montner, Steven
AU - Chung, Jonathan H.
AU - Noth, Imre
AU - Vij, Rekha
AU - Strek, Mary E.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Background Azathioprine is a commonly prescribed therapy for connective tissue disease-associated interstitial lung disease (CTD-ILD). Combination therapy that included azathioprine was recently shown to increase the risk of death and hospitalization in patients with idiopathic pulmonary fibrosis. Whether azathioprine increases the risk of adverse outcomes in patients with fibrotic CTD-ILD, including those with CTD-associated usual interstitial pneumonia (UIP), remains unknown. Methods A retrospective cohort analysis was performed to determine the combined incidence rate of death, transplant and respiratory hospitalization associated with azathioprine exposure. A fibrotic CTD-ILD cohort treated with mycophenolate mofetil served as a comparator group. Incidence rates were compared with an incidence rate ratio (IRR) generated by negative binomial regression. Longitudinal pulmonary function response was then assessed using mixed effects linear regression models. Results Fifty-four patients were treated with azathioprine and forty-three with mycophenolate. Medication discontinuation due to non-respiratory side effects occurred in 27% and 5% of the azathioprine and mycophenolate cohorts, respectively. The combined incidence rate of adverse outcomes was 0.015 and 0.013 for azathioprine and mycophenolate, respectively (IRR 1.23; 95% CI 0.49-3.12; p = 0.66). Similar incidence rates were observed among those with CTD-UIP (IRR 0.83; 95% CI 0.21-3.31; p = 0.79). Both groups demonstrated pulmonary function stability over time, with the azathioprine group demonstrating a marginal improvement. Conclusions A significant minority of patients could not tolerate azathioprine due to non-respiratory side effects. Of those who did tolerate azathioprine, a similar incidence of adverse outcomes was observed as those treated with mycophenolate. Both therapies were associated with stability in pulmonary function.
AB - Background Azathioprine is a commonly prescribed therapy for connective tissue disease-associated interstitial lung disease (CTD-ILD). Combination therapy that included azathioprine was recently shown to increase the risk of death and hospitalization in patients with idiopathic pulmonary fibrosis. Whether azathioprine increases the risk of adverse outcomes in patients with fibrotic CTD-ILD, including those with CTD-associated usual interstitial pneumonia (UIP), remains unknown. Methods A retrospective cohort analysis was performed to determine the combined incidence rate of death, transplant and respiratory hospitalization associated with azathioprine exposure. A fibrotic CTD-ILD cohort treated with mycophenolate mofetil served as a comparator group. Incidence rates were compared with an incidence rate ratio (IRR) generated by negative binomial regression. Longitudinal pulmonary function response was then assessed using mixed effects linear regression models. Results Fifty-four patients were treated with azathioprine and forty-three with mycophenolate. Medication discontinuation due to non-respiratory side effects occurred in 27% and 5% of the azathioprine and mycophenolate cohorts, respectively. The combined incidence rate of adverse outcomes was 0.015 and 0.013 for azathioprine and mycophenolate, respectively (IRR 1.23; 95% CI 0.49-3.12; p = 0.66). Similar incidence rates were observed among those with CTD-UIP (IRR 0.83; 95% CI 0.21-3.31; p = 0.79). Both groups demonstrated pulmonary function stability over time, with the azathioprine group demonstrating a marginal improvement. Conclusions A significant minority of patients could not tolerate azathioprine due to non-respiratory side effects. Of those who did tolerate azathioprine, a similar incidence of adverse outcomes was observed as those treated with mycophenolate. Both therapies were associated with stability in pulmonary function.
KW - Connective tissue disease
KW - Idiopathic pulmonary fibrosis
KW - Interstitial lung disease
KW - Mycophenolate mofetil
KW - Rheumatology
KW - Usual interstitial pneumonia
UR - http://www.scopus.com/inward/record.url?scp=84994885707&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84994885707&partnerID=8YFLogxK
U2 - 10.1016/j.rmed.2016.11.007
DO - 10.1016/j.rmed.2016.11.007
M3 - Article
C2 - 27888985
AN - SCOPUS:84994885707
VL - 121
SP - 117
EP - 122
JO - Respiratory Medicine
JF - Respiratory Medicine
SN - 0954-6111
ER -