TNF-α antagonist may not be suitable for severe rituximab-induced interstitial lung disease

Rituximab-induced interstitial lung disease (R-ILD) has aroused more concern in recent years. Anti-TNF-α treatment has been suggested for the treatment of severe R-ILD, due to the plausible suggestion that its pathogenesis is related to TNF-α. This commentary aimed to comment on the role of TNF-α antagonists in R-ILD.

Although most R-ILD patients respond well to glucocorticoids, other treatment options are needed for patients who are refractory to conventional treatment. Contrary to expectations, the TNF-α antagonist etanercept brought no benefit in R-ILD. Moreover, TNF-α-targeted therapies were reported to induce or exacerbate interstitial lung disease.

The role of TNF-α in the pathogenesis of R-ILD is still unclear due to limited studies on its aetiology. Use of TNF-α antagonists in R-ILD is still speculative, as clinical trials do not support its efficacy. What's more, TNF-α antagonists may themselves induce interstitial lung disease with poor prognosis.