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Original Research: Diffuse Lung Disease |

Use of Mycophenolate Mofetil or Azathioprine for the Management of Chronic Hypersensitivity Pneumonitis

Julie Morisset, MD; Kerri A. Johannson, MD; Eric Vittinghoff, PhD; Carlos Aravena, MD; Brett M. Elicker, MD; Kirk D. Jones, MD; Charlene D. Fell, MD; Helene Manganas, MD; Bruno-Pierre Dubé, MD; Paul J. Wolters, MD; Harold R. Collard, MD, FCCP; Christopher J. Ryerson, MD; Brett Ley, MD
Author and Funding Information

Drs Morisset and Johannson contributed equally to this manuscript.

FUNDING/SUPPORT: This work was supported by the Nina Ireland Program for Lung Health.

aDepartment of Medicine, University of California, San Francisco, San Francisco, CA

bDepartment of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA

cDepartment of Radiology, University of California, San Francisco, San Francisco, CA

dDepartment of Pathology, University of California, San Francisco, San Francisco, CA

eDepartment of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada

fDepartment of Medicine, University of Calgary, Calgary, AB, Canada

gDepartment of Respiratory Diseases, Pontifical Catholic University of Chile, Santiago, Chile

hDepartment of Medicine and Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada

CORRESPONDENCE TO: Julie Morisset, MD, 1560 Sherbrooke Est, Montreal, QC, Canada, H2L 4M1


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(3):619-625. doi:10.1016/j.chest.2016.10.029
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Background  The treatment of chronic hypersensitivity pneumonitis (cHP) often includes systemic oral corticosteroids, but the optimal pharmacologic management remains unclear. The morbidity associated with prednisone has motivated the search for alternative therapies. We aimed to determine the effect of treatment with mycophenolate mofetil (MMF) or azathioprine (AZA) on lung function in patients with cHP.

Methods  Patients with cHP treated with either MMF or AZA were retrospectively identified from four interstitial lung disease centers. Change in lung function before and after treatment initiation was analyzed using linear mixed-effects modeling (LMM), adjusting for age, sex, smoking history, and prednisone use.

Results  Seventy patients were included: 51 were treated with MMF and 19 with AZA. Median follow-up after treatment initiation was 11 months. Prior to treatment initiation, FVC and diffusion capacity of the lung for carbon monoxide (Dlco) % predicted were declining at a mean rate of 0.12% (P < .001) and 0.10% (P < .001) per month, respectively. Treatment with either MMF or AZA was not associated with improved FVC (0.5% at 1 year; P = .46) but was associated with a statistically significant improvement in Dlco of 4.2% (P < .001) after 1 year of treatment. Results were similar in the subgroup of patients treated with MMF for 1 year; the FVC increased nonsignificantly by 1.3% (P = .103) and Dlco increased by 3.9% (P < .001).

Conclusions  Treatment with MMF or AZA is associated with improvements in Dlco in patients with cHP. Prospective randomized trials are needed to validate their effectiveness for cHP.

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