Abstract
Introduction: Drug induced interstitial lung disease(DIILD) occurs as a result of numerous agents but the risk is often not recognised until after marketing authorisation. In this PRISMA compliant systematic review we aimed to evaluate and synthesise the current literature on DIILD to inform prospective studies.
Methods: A PRISMA compliant systematic review:searches in Medline, Embase and The Cochrane Register of Controlled Trials in May 2017 using keywords and MESH headings. Quality and bias were assessed using GRADE criteria. Data evaluated for inclusion in a meta-analysis based on quality and bias and, if excluded, descriptive synthesis was undertaken.
Results: 156 full text papers describing >6000 cases of DIILD included. The majority were of low/ very low quality in relation to the review question (78%). Most had significant risk of bias. It was not possible to perform meta-analysis. Descriptive review was undertaken. DIILD incidence rates varied between 4.1-12.4 cases/million/year and DIILD accounted for 3- 5% of prevalent ILD cases. Cancer drugs followed by rheumatology drugs, amiodarone and antibiotics were the most common causes of DIILD. The radiopathological phenotype of DIILD varied between and within agents and no typical radiological pattern was identified which was specific to DIILD. Mortality rates of >50% were reported with some agents. Severity at presentation was the most reliable predictor of mortality. Glucocorticoids(GCs) were commonly used to treat DIILD but no prospective studies examined the effect of GCs on outcome.
Conclusion: High quality evidence in DIILD is lacking and the current review will inform larger prospective studies to investigate the diagnosis and management of DIILD.
Methods: A PRISMA compliant systematic review:searches in Medline, Embase and The Cochrane Register of Controlled Trials in May 2017 using keywords and MESH headings. Quality and bias were assessed using GRADE criteria. Data evaluated for inclusion in a meta-analysis based on quality and bias and, if excluded, descriptive synthesis was undertaken.
Results: 156 full text papers describing >6000 cases of DIILD included. The majority were of low/ very low quality in relation to the review question (78%). Most had significant risk of bias. It was not possible to perform meta-analysis. Descriptive review was undertaken. DIILD incidence rates varied between 4.1-12.4 cases/million/year and DIILD accounted for 3- 5% of prevalent ILD cases. Cancer drugs followed by rheumatology drugs, amiodarone and antibiotics were the most common causes of DIILD. The radiopathological phenotype of DIILD varied between and within agents and no typical radiological pattern was identified which was specific to DIILD. Mortality rates of >50% were reported with some agents. Severity at presentation was the most reliable predictor of mortality. Glucocorticoids(GCs) were commonly used to treat DIILD but no prospective studies examined the effect of GCs on outcome.
Conclusion: High quality evidence in DIILD is lacking and the current review will inform larger prospective studies to investigate the diagnosis and management of DIILD.
| Original language | English |
|---|---|
| Article number | PA2244 |
| Journal | European Respiratory Journal |
| Volume | 52 |
| Issue number | Suppl 62 |
| DOIs | |
| Publication status | Published online - 19 Nov 2018 |
