Skip to main content

Advertisement

SpringerLink
Log in

A fatal case of acute exacerbation of interstitial lung disease in a patient with rheumatoid arthritis during treatment with tocilizumab

  • Case Report
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

A 68-year-old man, who was a patient with established rheumatoid arthritis (RA) with RA-associated interstitial lung disease (RA-ILD) and pulmonary emphysema, began taking tocilizumab. Subsequently, he developed dyspnea parallel to improvement of RA. At 10 months after the administration of tocilizumab, he was urgently admitted because of exacerbation of ILD. He died despite receiving steroid pulse therapy and antibiotic therapy on a respirator. This is the first case report to describe the exacerbation of ILD during treatment with tocilizumab in the postmarketing surveillance (PMS) period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Abbreviations

CRP:

C-reactive protein

CT:

Computed tonography

DAS:

Disease activity score

ILD:

Interstitial lung disease

PCP:

Pneumocystis pneumonia

PMS:

Postmarketing surveillance

PSL:

Prednisolone

RA:

Rheumatoid arthritis

RCT:

Randomized control trial

TNF:

Tumor necrosis factor

UIP:

Usual interstitial pneumonia

References

  1. Mihara M, Kasutani K, Okazaki M, Nakamura A, Kawai S, Sugimoto M et al (2005) Tocilizumab inhibits signal transduction mediated by both mIL-6R and sIL-6R, but not by the receptors of other members of IL-6 cytokine family. Int Immunopharmacol 5:1731–1740

    Article  PubMed  CAS  Google Scholar 

  2. Nishimoto N, Hashimoto J, Miyasaka N, Yamamoto K, Kawai S, Takeuchi T et al (2007) Study of active controlled monotherapy used for rheumatoid arthritis, an IL-6 inhibitor (SAMURAI): evidence of clinical and radiographic benefit from an x ray reader-blinded randomised controlled trial of tocilizumab. Ann Rheum Dis 66:1162–1167

    Article  PubMed  CAS  Google Scholar 

  3. Nishimoto N, Miyasaka N, Yamamoto K, Kawai S, Takeuchi T, Azuma J et al (2009) Study of active controlled tocilizumab monotherapy for rheumatoid arthritis patients with an inadequate response to methotrexate (SATORI): significant reduction in disease activity and serum vascular endothelial growth factor by IL-6 receptor inhibition therapy. Mod Rheumatol 19:12–19

    Article  PubMed  CAS  Google Scholar 

  4. Smolen JS, Beaulieu A, Rubbert-Roth A, Ramos-Remus C, Rovensky J, Alecock E et al (2008) TOPTION Investigators. Effect of interleukin-6 receptor inhibition with tocilizumab in patients with rheumatoid arthritis (OPTION study): a double-blind, placebo-controlled, randomised trial. Lancet 371:987–997

    Article  PubMed  CAS  Google Scholar 

  5. Genovese MC, McKay JD, Nasonov EL, Mysler EF, da Silva NA, Alecock E et al (2008) Interleukin-6 receptor inhibition with tocilizumab reduces disease activity in rheumatoid arthritis with inadequate response to disease-modifying antirheumatic drugs: the tocilizumab in combination with traditional disease-modifying antirheumatic drug therapy study. Arthritis Rheum 58:2968–2980

    Article  PubMed  CAS  Google Scholar 

  6. Jones G, Sebba A, Gu J, Lowenstein MB, Calvo A, Gomez-Reino JJ, Siri DA et al (2010) Comparison of tocilizumab monotherapy versus methotrexate monotherapy in patients with moderate to severe rheumatoid arthritis: The AMBITION study. Ann Rheum Dis 69:88–96

    Article  PubMed  CAS  Google Scholar 

  7. Emery P, Keystone E, Tony HP, Cantagrel A, van Vollenhoven R, Sanchez A et al (2008) IL-6 receptor inhibition with tocilizumab improves treatment outcomes in patients with rheumatoid arthritis refractory to anti-tumour necrosis factor biologicals: results from a 24-week multicentre randomised placebo-controlled trial. Ann Rheum Dis 67:1516–1523

    Article  PubMed  CAS  Google Scholar 

  8. Hagiwara K, Sato T, Takagi-Kobayashi S, Hasegawa S, Shigihara N, Akiyama O (2007) Acute exacerbation of preexisting interstitial lung disease after administration of etanercept for rheumatoid arthritis. J Rheumatol 34:1151–1154

    PubMed  Google Scholar 

  9. Chatterjee S (2004) Severe interstitial pneumonitis associated with infliximab therapy. Scand J Rheumatol 33:276–277

    Article  PubMed  CAS  Google Scholar 

  10. Villeneuve E, St-Pierre A, Haraoui B (2006) Interstitial pneumonitis associated with infliximab therapy. J Rheumatol 33:1189–1193

    PubMed  Google Scholar 

  11. Takeuchi T, Tatsuki Y, Nogami Y, Ishiguro N, Tanaka Y, Yamanaka H et al (2008) Postmarketing surveillance of the safety profile of infliximab in 5000 Japanese patients with rheumatoid arthritis. Ann Rheum Dis 67:189–194

    Article  PubMed  CAS  Google Scholar 

  12. Harigai M, Koike R, Miyasaka N (2007) Pneumocystis Pneumonia under Anti-Tumor Necrosis Factor Therapy (PAT) Study Group. Pneumocystis pneumonia associated with infliximab in Japan. N Engl J Med 357:1874–1876

    Article  PubMed  CAS  Google Scholar 

  13. Komano Y, Harigai M, Koike R, Sugiyama H, Ogawa J, Saito K et al (2009) Pneumocystis jiroveci pneumonia in patients with rheumatoid arthritis treated with infliximab: a retrospective review and case-control study of 21 patients. Arthritis Rheum 61:305–312

    Article  PubMed  CAS  Google Scholar 

  14. Wolfe F, Caplan L, Michaud K (2006) Treatment for rheumatoid arthritis and the risk of hospitalization for pneumonia: associations with prednisone, disease-modifying antirheumatic drugs, and anti-tumor necrosis factor therapy. Arthritis Rheum 54:628–634

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unit of Translational Medicine, Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Shin-ya Kawashiri, Atsushi Kawakami & Katsumi Eguchi

  2. Second Department of Internal Medicine, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Noriho Sakamoto & Yuji Ishimatsu

Authors
  1. Shin-ya Kawashiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Atsushi Kawakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Noriho Sakamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuji Ishimatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Katsumi Eguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shin-ya Kawashiri.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kawashiri, Sy., Kawakami, A., Sakamoto, N. et al. A fatal case of acute exacerbation of interstitial lung disease in a patient with rheumatoid arthritis during treatment with tocilizumab. Rheumatol Int 32, 4023–4026 (2012). https://doi.org/10.1007/s00296-010-1525-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-010-1525-z

Keywords

Search

Navigation