• Chest · Mar 2017

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

    • Julie Morisset, Kerri A Johannson, Eric Vittinghoff, Carlos Aravena, Brett M Elicker, Kirk D Jones, Charlene D Fell, Helene Manganas, Bruno-Pierre Dubé, Paul J Wolters, Harold R Collard, Christopher J Ryerson, and Brett Ley.
    • Department of Medicine, University of California, San Francisco, San Francisco, CA; Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada. Electronic address: julie.morisset@umontreal.ca.
    • Chest. 2017 Mar 1; 151 (3): 619-625.

    BackgroundThe 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.MethodsPatients 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.ResultsSeventy 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).ConclusionsTreatment 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.Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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