Pneumotox » Drug » Tocilizumab

Tocilizumab

1

For those ILD cases exposed to methotrexate concomitantly, drug causality assessment can be difficult. A meta-analysis in 2018 'did not reveal an increase in the risk of non-infectious respiratory AEs in adult patients with RA who were treated with tocilizumab compared with other DMARDs' (PMID 30183597)

Last update : 10/10/2018

I.b Pneumonitis (ILD)

1

I.d Organizing pneumonia pattern (an area or areas of consolidation on imaging)

1

I.y Progression, acceleration or exacerbation of preexisting ILD/fibrosis

1

VIII.h Vocal cord dysfunction, adduction, closure, injury

1

X.k Sarcoid-like granulomatosis (endo-/extrathoracic)

1

XVII.b Opportunistic pulmonary/systemic infections

1

XVII.g Tuberculosis (pulmonary, pulmonary, extrapulmonary or disseminated). Reactivation or de novo

1

XVII.ah Pulmonary pasteurellosis

1

Diagnosing DIRD

1

Drug and radiation history

2

Drug singularity - Correct identification of the drug

3

Consistent timing of exposure v. onset of symptoms

4

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

5

Careful exlusion of another cause

6

Remission of symptoms with removal of drug

7

Recurrence with rechallenge (rarely advisable)

8

Causality assessment

More detailed checklist