Adalimumab-Induced Interstitial Pneumonias
Evidence for Adalimumab-Induced Interstitial Pneumonias
- The American College of Chest Physicians guidelines state that pulmonary fibrosis as either a new event or exacerbation of underlying fibrosis has been reported in patients treated with adalimumab, and overall, interstitial pneumonias have been reported in at least 18 patients receiving various anti-TNF agents 1, 2
Clinical Recognition and Diagnosis
- The European consensus notes that anti-TNF monoclonal antibodies can cause granulomatous inflammation compatible with sarcoidosis, which improves with cessation of the anti-TNF agent and/or steroid treatment 3
- The identification of pulmonary drug reaction requires stringent interdisciplinary correlation between clinical presentation, radiographic findings, and temporal relationship to drug exposure 3
Management Algorithm
- If drug-induced pneumonitis from adalimumab is suspected, the primary intervention is immediate discontinuation of the drug, followed by initiation of corticosteroids 3
- Do not rechallenge with the drug, as anti-TNF-induced pulmonary inflammation typically requires permanent discontinuation 3
Expected Response
- Organizing pneumonia typically responds well to corticosteroids, with the majority of patients recovering completely with oral corticosteroids 4
- Some cases do not completely resolve despite prolonged treatment, characterized by residual or progressive interstitial fibrosis 4
Important Clinical Pitfalls
- Patients with inflammatory bowel disease have increased baseline risk of pulmonary manifestations independent of drug therapy 3
Monitoring Recommendations
- The American College of Chest Physicians recommends baseline chest radiograph prior to therapy 1, 2
- High clinical suspicion for new respiratory symptoms during treatment 3
- High-resolution CT when interstitial pneumonitis is suspected 3