دورية أكاديمية
Impact of Antigen Exposure on Outcomes and Treatment Response in Fibrotic Hypersensitivity Pneumonitis.
| العنوان: | Impact of Antigen Exposure on Outcomes and Treatment Response in Fibrotic Hypersensitivity Pneumonitis. |
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| المؤلفون: | Mullin ML; Department of Medicine, University of British Columbia, Vancouver, BC, Canada., Fernandez G; Luis Razetti School of Medicine, Central University of Venezuela, Caracas, Venezuela., Marinescu DC; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada; Centre for Lung Health, Vancouver General Hospital, Vancouver, BC, Canada., Zheng B; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada., Wong AW; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada., Assayag D; Department of Medicine, McGill University, Montreal, QC, Canada., Fisher JH; Department of Medicine, University of Toronto, Toronto, ON, Canada., Johannson KA; Department of Medicine, University of Calgary, Calgary, AB, Canada., Khalil N; Department of Medicine, University of British Columbia, Vancouver, BC, Canada., Kolb M; Department of Medicine, McMaster University, Hamilton, ON, Canada., Manganas H; Département de Médecine, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada., Marcoux V; Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada., Morisset J; Département de Médecine, Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada., Min B; Department of Medicine, University of Calgary, Calgary, AB, Canada., Farrand E; Department of Medicine, University California San Francisco, San Francisco, CA., Ryerson CJ; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada. Electronic address: Chris.Ryerson@hli.ubc.ca. |
| المصدر: | Chest [Chest] 2024 Jun; Vol. 165 (6), pp. 1435-1443. Date of Electronic Publication: 2023 Dec 19. |
| نوع المنشور: | Journal Article; Multicenter Study |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 0231335 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1931-3543 (Electronic) Linking ISSN: 00123692 NLM ISO Abbreviation: Chest Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2016- : New York : Elsevier Original Publication: Chicago : American College of Chest Physicians |
| مواضيع طبية MeSH: | Alveolitis, Extrinsic Allergic*/physiopathology , Alveolitis, Extrinsic Allergic*/diagnosis , Alveolitis, Extrinsic Allergic*/immunology , Immunosuppressive Agents*/therapeutic use , Mycophenolic Acid*/therapeutic use, Humans ; Male ; Female ; Aged ; Middle Aged ; Azathioprine/therapeutic use ; Treatment Outcome ; Canada/epidemiology ; Antigens/immunology ; Retrospective Studies ; Registries |
| مستخلص: | Background: Patients with fibrotic hypersensitivity pneumonitis (fHP) are frequently treated with immunosuppression to slow lung function decline; however, the impact of this treatment has not been studied across different types of antigen exposure. Research Question: In patients with fHP, do disease outcomes and response to treatment vary by antigen type? Study Design and Methods: A multicenter interstitial lung disease database (Canadian Registry for Pulmonary Fibrosis) was used to identify patients with fHP. The causative antigen was categorized as avian, mold, unknown, or other. Treatment was defined as mycophenolate ≥ 1,000 mg/d or azathioprine ≥ 75 mg/d for ≥ 30 days. Statistical analysis included t tests, χ 2 tests, and one-way analysis of variance. Unadjusted and adjusted competing risks and Cox proportional hazards models were used to assess survival. Results: A total of 344 patients were identified with the following causative antigens: avian (n = 93; 27%), mold (n = 88; 26%), other (n = 15; 4%), and unknown (n = 148; 43%). Patient characteristics and lung function were similar among antigen groups with a mean FVC % predicted of 75 ± 20. The percent of patients treated with immunosuppression was similar between antigens with 58% of patients treated. There was no change in lung function or symptom scores with the initiation of immunosuppression in the full cohort. Immunosuppression was not associated with a change in survival for patients with avian or mold antigen (avian: hazard ratio, 0.41; 95% CI, 0.11-1.59; P = .20; mold: hazard ratio, 1.13; 95% CI, 0.26-4.97; P = .88). For patients with unknown causative antigen, survival was worse when treated with immunosuppression (hazard ratio, 2.65; 95% CI, 1.01-6.92; P = .047). Interpretation: Response to immunosuppression varies by antigen type in patients with fHP. Additional studies are needed to test the role of immunosuppression in fHP, and particularly in those with an unknown antigen. Competing Interests: Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: A. W. W. reports personal fees from Boehringer Ingelheim and Astra Zeneca, outside the submitted work. V. M. reports personal fees from Boehringer Ingelheim Canada, Hoffman-La Roche Ltd, and Astra Zeneca; and reports grants from the University of Saskatchewan, Royal University Hospital Foundation, Boehringer Ingelheim, Astra Zeneca, and Hoffman-La Roche. D.-C. M. reports consultancy and speaking fees from Boehringer Ingelheim. B. Z. reports speaking fees from Boehringer Ingelheim and Abbvie. D. A. is supported by the Fonds de Recherche du Quebec en Santé, reports personal fees and grants from Boehringer Ingelheim, reports personal fees from Hoffmann-La Roche, and reports grants from the Canadian Institute for Health Research. K. A. J. reports grants from Boehringer Ingelheim, Pulmonary Fibrosis Society of Calgary, and University of Calgary School of Medicine; and reports personal fees from Boehringer Ingelheim, Roche, Three Lakes Foundation, Pliant Therapeutics, Theravance, and Blade Therapeutics. M. K. reports grants from the Canadian Institute for Health Research, Roche, Boehringer Ingelheim, Pieris, and Prometic; and reports personal fees from Boehringer Ingelheim, Roche, European Respiratory Journal, Belerophon, United Therapeutics, Nitto Denko, MitoImmune, Pieris, Abbvie, DevPro Biopharma, Horizon, Algernon, and CSL Behring. H. M. reports grants from Boehringer Ingelheim and Gilead. J. M. reports personal fees from Boehringer Ingelheim and Roche. C. J. R. reports grants from Boehringer Ingelheim; and reports personal fees from Astra Zeneca, Boehringer Ingelheim, Roche, Pliant Therapeutics, Cipla, and Veracyte. None declared (M. L. M., G. F., J. H. F., N. K., B. M., E. F.). (Copyright © 2023 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: diffuse lung disease; hypersensitivity pneumonitis; immunosuppression; interstitial lung disease; lung function |
| المشرفين على المادة: | 0 (Immunosuppressive Agents) HU9DX48N0T (Mycophenolic Acid) MRK240IY2L (Azathioprine) 0 (Antigens) |
| تواريخ الأحداث: | Date Created: 20231221 Date Completed: 20240609 Latest Revision: 20240823 |
| رمز التحديث: | 20240823 |
| DOI: | 10.1016/j.chest.2023.12.019 |
| PMID: | 38128609 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1931-3543 |
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| DOI: | 10.1016/j.chest.2023.12.019 |