Outcomes of immunosuppressive therapy in chronic hypersensitivity pneumonitis

Ayodeji Adegunsoye, Justin Oldham, Evans R. Fernández Pérez, Mark Hamblin, Nina Patel, Mitchell Tener, Deepa Bhanot, Lacey Robinson, Sam Bullick, Lena Chen, Scully Hsu, Matthew Churpek, Donald Hedeker, Steven Montner, Jonathan H. Chung, Aliya N. Husain, Imre Noth, Mary E. Strek, Rekha Vij

Research output: Contribution to journalArticle

Abstract

In chronic hypersensitivity pneumonitis (CHP), lack of improvement or declining lung function may prompt use of immunosuppressive therapy. We hypothesised that use of azathioprine or mycophenolate mofetil with prednisone reduces adverse events and lung function decline, and improves transplant-free survival. Patients with CHP were identified. Demographic features, pulmonary function tests, incidence of treatment-emergent adverse events (TEAEs) and transplant-free survival were characterised, compared and analysed between patients stratified by immunosuppressive therapy. A multicentre comparison was performed across four independent tertiary medical centres. Among 131 CHP patients at the University of Chicago medical centre (Chicago, IL, USA), 93 (71%) received immunosuppressive therapy, and had worse baseline forced vital capacity (FVC) and diffusing capacity, and increased mortality compared with those who did not. Compared to patients treated with prednisone alone, TEAEs were 54% less frequent with azathioprine therapy (p=0.04) and 66% less frequent with mycophenolate mofetil (p=0.002). FVC decline and survival were similar between treatment groups. Analyses of datasets from four external tertiary medical centres confirmed these findings. CHP patients who did not receive immunosuppressive therapy had better survival than those who did. Use of mycophenolate mofetil or azathioprine was associated with a decreased incidence of TEAEs, and no difference in lung function decline or survival when compared with prednisone alone. Early transition to mycophenolate mofetil or azathioprine may be an appropriate therapeutic approach in CHP, but more studies are needed.

Original languageEnglish (US)
Article number00016-2017
JournalERS Monograph
Volume3
Issue number3
DOIs
StatePublished - Jul 1 2017

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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    Adegunsoye, A., Oldham, J., Fernández Pérez, E. R., Hamblin, M., Patel, N., Tener, M., Bhanot, D., Robinson, L., Bullick, S., Chen, L., Hsu, S., Churpek, M., Hedeker, D., Montner, S., Chung, J. H., Husain, A. N., Noth, I., Strek, M. E., & Vij, R. (2017). Outcomes of immunosuppressive therapy in chronic hypersensitivity pneumonitis. ERS Monograph, 3(3), [00016-2017]. https://doi.org/10.1183/23120541.00016-2017