Adverse effects of biologic anti-inflammatory agents on the respiratory system: A review

Area of Science:

• Rheumatology
• Pulmonology
• Pharmacology

Background:

• Autoimmune rheumatological conditions are increasingly treated with biologic anti-inflammatory agents.
• These advanced therapies include cytokine antagonists, T/B cell modulators, and Janus kinase (JAK) inhibitors.
• A significant concern is drug-induced lung disease, mimicking or exacerbating underlying autoimmune pulmonary disorders.

Purpose of the Study:

• To review infectious and non-infectious lung diseases associated with biologic anti-inflammatory therapies.
• To highlight the diagnostic challenges in differentiating drug-induced lung disease from autoimmune-related pulmonary conditions.
• To focus on lung complications from specific biologic agents, including TNF, IL-1, IL-6, and JAK inhibitors.

Main Methods:

• Literature review of studies on biologic therapies and associated lung diseases.
• Analysis of case reports and clinical trials detailing pulmonary adverse events.
• Synthesis of information on the mechanisms and clinical presentation of drug-induced lung disease.

Main Results:

• Biologic agents, while controlling inflammation, can precipitate diverse lung pathologies.
• Distinguishing drug-induced lung disease from autoimmune-related lung issues is clinically challenging.
• Specific examples of infectious and non-infectious lung diseases linked to TNF, IL-1, IL-6, and JAK inhibitors are discussed.

Conclusions:

• Awareness of potential drug-induced lung disease is crucial for clinicians managing autoimmune conditions.
• Early recognition and differentiation are key to appropriate patient management and treatment adjustments.
• Further research is needed to refine diagnostic strategies and management protocols for these complex pulmonary complications.