Tocilizumab-Induced Lung Disease

Diagnostic Approach

• The American Thoracic Society recommends obtaining chest CT immediately when pneumonitis is suspected, looking for organizing pneumonia pattern or NSIP pattern, to establish a temporal correlation between tocilizumab administration and symptom onset 1, 2
• Exclusion of infection is crucial and can be performed through bronchoscopy with bronchoalveolar lavage to rule out infectious causes, including culture and PCR testing 3

Management

• The European Respiratory Society suggests that immediately discontinuing tocilizumab is the primary intervention if tocilizumab-induced organizing pneumonia is suspected, and initiating corticosteroids for moderate to severe cases 3, 4
• The American College of Rheumatology recommends not rechallenging with tocilizumab, as drug-induced pulmonary inflammation typically requires permanent discontinuation 3, 4

Patient Risk Factors

• Patients with rheumatoid arthritis and other inflammatory conditions have a baseline increased risk of interstitial lung disease independent of drug therapy, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases 3, 4