Role of Immunosuppressive Therapies in Managing ILD

The balance between the benefits and risks of immunosuppressive therapies for patients with interstitial lung disease (ILD) is managed by monitoring side effects and considering alternative treatments or dosage adjustments, says Anna-Maria Hoffmann-Vold, MD, PhD, a senior consultant and leader of inflammatory and fibrotic research area at Oslo University Hospital.

This transcript was lightly edited.

Transcript

Could you explain the role of immunosuppressive therapies in managing ILD associated with rheumatic diseases, and how do you balance the benefits with the risks of potential side effects?

We often treat our patients with rheumatic disease and interstitial lung disease with immunosuppression. This is because the drugs we have available and have been tested in randomized trials have mostly been immunosuppressive therapies. In addition, our patients often have other organ manifestations. Systematherosomes often has skin disease, rheumatoid arthritis often has joint disease, and these other organ manifestations are also targeted by immunosuppression. So, this is the reason why we treat a lot of rheumatic disease patients with immunosuppression, to both target the lung and other organs. But again, every therapy has side effects. Typical side effects are infections for most immunosuppressive treatments, and these can be harmful for the lung if it's pneumonia or other infections. So, there's always this balance, and we do talk to the patient [on] whether they develop side effects. If they do, we need to consider either using a different treatment option, reducing the dose, or going over to an anti-fibrotic therapy, for example.

What are the latest advancements in treatment or management strategies, and how do they impact patient outcomes in terms of lung function and quality of life?

This year, very recently, the ACR/CHEST [The American College of Rheumatology/American College of Chest Physicians] guidelines for the management [and] treatment of ILD and rheumatic diseases has been published. We are also waiting for the ERA/EULAR [European Renal Association/European League Against Rheumatism] guidelines, where I have been one of the conveners from the rheumatic side with Oliver Distler [Oliver Distler, MD, professor of rheumatology and director of the Department of Rheumatology and the Center of Experimental Rheumatology at the University of Zurich], and from the pulmonary side, Katarina Antoniou [Katarina Antoniou, MD, PhD, professor of respiratory medicine at the University of Crete] and Bruno Crestani [Bruno Crestani, MD, professor of pneumology at the Paris-Diderot University, head of the Department of Pneumology at Bichat Hospital - Claude Bernard]. We are waiting for these guidelines to be published later this year. And again, these are hampered, of course by the lack of a lot of randomized trials, but in the future, we will have more trials. That is very important to place the right therapy for the right patient.