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Original Research |

Use of mycophenolate mofetil or azathioprine for the management of chronic hypersensitivity pneumonitis

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

Summary of conflict of interest statements: JM has no conflict of interest. KAJ reports personal fees from Hoffman-La Roche and Boehringer-Ingelheim, outside of the submitted work. EV has no conflict of interest. CA has no conflict of interest. BME has no conflict of interest. KDJ has no conflict of interest. CDF has no conflict of interest. HM has no conflict of interest. BPD has no conflict of interest. PJW has no conflict of interest. HRC reports personal fees from AstraZeneca/Medimmune, Bayer, Biogen, Boehringer Ingelheim, Genentech/Roche, Genoa, Gilead, GlaxoSmithKline, Mesoblast, Moerae Matrix, Pharmakea, Promedior, Prometic, Pulmatrix, Unity, Aeolus, aTry pharmaceuticals, Grunenthal, UCB Celltech, GBT and Veracyte, outside of the submitted work. CJR reports grants and personal fees from Boehringer Ingelheim and Hoffmann La Roche, outside the submitted work. BL has no conflict of interest.

Sources: This work was supported by the Nina Ireland Program for Lung Health.

1Department of Medicine, University of California San Francisco, San Francisco, CA, United States

2Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada

3Department of Medicine, University of Calgary, Calgary, Alberta, Canada

4Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States

5Department of Respiratory Diseases, Pontifical Catholic University of Chile, Santiago, Chile

6Department of Radiology, University of California, San Francisco, CA, United States

7Department of Pathology, University of California, San Francisco, CA, United States

8Department of Medicine and Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Colombia, Canada

Corresponding author contact information Julie Morisset, M.D., 1560 Sherbrooke Est, Montréal, Qc, Canada, H2L 4M1.


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


Chest. 2016. doi:10.1016/j.chest.2016.10.029
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Abstract

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 effect modeling, 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, forced vital capacity (FVC) and diffusion capacity of the lung for carbon monoxide (DLCO) %-predicted were declining at a mean rate of 0.12% (p < 0.001) and 0.10% (p < 0.001) per month, respectively. Treatment with either MMF or AZA was not associated with improved FVC (0.5% at 1 year, p=0.46) but was associated with a statistically significant improvement in DLCO of 4.2% (p<0.001) after 1 year of treatment. Results were similar in the subgroup of patients treated with MMF for 1 year; the FVC non-significantly increased by 1.3% (p=0.103) and DLCO increased by 3.9% (p<0.001).

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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