The Drug-Induced Respiratory Disease Website and App

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I.b

Pneumonitis (ILD), acute and/or severe (may cause ARDS)

Although a temporal association with exposure to the drug may exist, evidence for causality is not strong.�For those cases exposed to methotrexate concomitantly, drug causality assessment is even more difficult.�Ruling out an infection is crucially important.�ILD cases with combo DMARD treatments (methotrexate + TNF-alpha antagonist) (e.g. PMID 24626274)�are not included due un uncertain causality. Evidence accumulates from epidmiologic studies indicating that anti-TNF agents are not associated with the development of ILD (PMID 23359391)

Publications

Perez-Alvarez R, Perez-de-Lis M, Diaz-Lagares C, Pego-Reigosa JM, Retamozo S, Bove A, Brito-Zeron P, Bosch X, Ramos-Casals M

Interstitial lung disease induced or exacerbated by TNF-targeted therapies: analysis of 122 cases.

Seminars in arthritis and rheumatism 2011 Oct;41;256-64 — 2011 Oct — 256-64

Khasnis AA, Calabrese LH

Tumor necrosis factor inhibitors and lung disease: a paradox of efficacy and risk.

Seminars in arthritis and rheumatism 2010 Oct;40;147-63 — 2010 Oct — 147-63