Certolizumab-Associated Pulmonary Toxicity
Introduction to Anti-TNF Agent Pulmonary Toxicity
- The European consensus on inflammatory bowel disease extra-intestinal manifestations notes that granulomatous inflammation compatible with sarcoidosis has been documented in patients receiving anti-TNF monoclonal antibodies, which improves with cessation of the anti-TNF agent and/or steroid treatment, indicating that anti-TNF biologics can cause pulmonary inflammatory reactions 1, 2
Organizing Pneumonia Characteristics
- Presents with subacute illness with cough and dyspnea, typically less than 3 months duration, and is characterized by intraluminal plugs of connective tissue in bronchioles extending into alveolar ducts and alveoli 3, 4
- HRCT shows patchy, often migratory consolidation in subpleural, peribronchial, or bandlike pattern 3, 4
Clinical Approach When Suspecting Drug-Induced Pneumonitis
- The identification of pulmonary drug reaction requires stringent interdisciplinary correlation between clinical presentation, radiographic findings, and temporal relationship to drug exposure, with key diagnostic steps including temporal correlation, exclusion of infection, radiographic pattern recognition, and multidisciplinary discussion 5, 6
- Exclusion of infection is done through bronchoscopy with bronchoalveolar lavage to rule out infectious causes 5, 6
Management Algorithm
- If drug-induced pneumonitis from certolizumab is suspected, the primary intervention is immediate discontinuation of the drug, followed by initiation of corticosteroids, with the route depending on severity 1, 2
- Do not rechallenge with the drug, as anti-TNF-induced pulmonary inflammation typically requires permanent discontinuation 1, 2