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Lung disease treatment shown to have fewer side effects

A new study has shown the drug rituximab could help treat chronic lung disease in some people with fewer side effects.

People with connective tissue diseases (CTD) can develop interstitial lung disease (ILD), a life-threatening condition that affects their ability to breathe.

CTD-ILD causes inflammation and scarring of the lungs. The standard treatment is cyclophosphamide, but this often causes severe side effects. Rituximab is also often given to these patients, but until now there has been little evidence to support its use.

New evidence from the RECITAL study now shows that, while both drugs improved patients’ lung function and respiratory-related quality of life, rituximab had fewer side effects.

University Hospital Southampton (UHS) was the second of 11 centres in the UK to recruit patients into the study.

The results are published in The Lancet Respiratory Medicine.

What is connective tissue disease?

CTD (Connective Tissue Disease) is a group of diseases that includes autoimmune diseases such as lupus, rheumatoid arthritis, systemic sclerosis, idiopathic inflammatory myositis, and mixed connective tissue disease.

In autoimmune diseases, the immune system malfunctions and attacks the body’s own tissues, causing inflammation. In these conditions it is the connective tissues that are damaged. When this affects the lungs, it can result in ILD (Interstitial Lung Disease), causing the lungs to become scarred and inflamed.

Providing another treatment option

The standard treatment for CTD-ILD is cyclophosphamide. While this works, it comes with side effects. These include nausea, an upset stomach and blood in the urine. It can also stop the ovaries or testes working properly, sometimes causing infertility, and increases the risk of bladder cancer.

This study compared the two drugs. Patients aged 18–80 years with severe or progressive ILD related to scleroderma, idiopathic inflammatory myositis, or mixed CTD took part.

They were randomly assigned to either receive cyclophosphamide or rituximab. For 24 weeks, they did a regular test where they had to blow as hard as they could into a tube to measure their lung capacity. They also completed a questionnaire which asked about their quality of life.

While both groups had improved lung capacity and a better quality of life after 24 weeks, those who took rituximab reported fewer side effects (445) than those receiving cyclophosphamide (646). They also took fewer steroids to help manage their condition.

Dr Sophie Fletcher, UHS Consultant Physician and study co-author, said: “This study is immediately directly relevant to clinical practice. It provides evidence that both drugs are equally effective, but Rituximab carries less steroid related side effects.”

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