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Tumor necrosis factor inhibitors and lung disease: A paradox of efficacy and risk
Seminars in Arthritis and Rheumatism, 11/20/09

Khasnis AA et al. – In this review, we have attempted to synthesize the available literature regarding noninfectious complications related to TNFi use. Serious and potentially fatal pulmonary toxicity has been reported during the use of TNFi, specifically from pulmonary fibrosis. Increased awareness during trial design and increased postmarketing surveillance is needed to provide more information about the epidemiology of these complications. Early recognition of these complications may help avert therapeutic misadventures.

Methods

Case reports, case series, and clinical trials reviewed

Results

Currently reported noninfectious pulmonary complications related to TNFi use include most commonly granulomatous disease and pulmonary fibrosis/interstitial lung disease and rarely alveolar hemorrhage and antisynthetase syndrome
De novo granulomatous disease seems mostly reversible, whereas pulmonary fibrosis carries worst prognosis especially in setting of prior lung fibrosis