Does tocilizumab treatment aggravate lung disease in patients with rheumatoid arthritis?

This study looked at the risk of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) during tocilizumab (Actemra) treatment. The authors concluded that patients over 60, smokers, or patients not responding well to tocilizumab treatment are at greater risk of developing ILD.

Interstitial lung disease (ILD) is a condition where the tissue in the lungs becomes inflamed and scarred. This can lead to shortness of breath and coughing and can become severe. ILD is a common problem for patients with RA, but the reason for this is currently not clear.

There is some evidence suggesting that treating RA patients with ILD with methotrexate (Rheumatrex) may make the condition worse. Serious cases of ILD have also been reported in RA patients receiving treatment with anti-tumor necrosis factor (TNF) drugs or tocilizumab. However, evidence to this effect is mixed. The risk factors of ILD in patients with RA have not been fully studied.

The records of 395 RA patients receiving treatment with tocilizumab were analyzed in this study. 78 of these were positive for ILD (RA-ILD). 317 showed no signs of ILD (non-ILD).

Patients over 60 were 4.5 times more likely to develop ILD. Smokers were 2.9 times more likely to develop ILD and patients with high levels of proteins associated with RA in their blood were 2.8 times more likely to develop ILD.

RA-ILD patients who had not responded well after 24 weeks of tocilizumab treatment (they had a higher disease activity) were 4.7 times more likely to experience severe ILD. 

The authors concluded that ILD in RA patients is associated with older age, smoking habits, and high RA protein levels. Lung disease may get worse in patients who do not respond well to tocilizumab treatment.

One of the authors has previously received funding from the drug company that manufactures tocilizumab.