Severe interstitial lung disease following treatment with certolizumab pegol: a case report

Abstract

To the Editor: Over the past decade, the understanding of autoimmune diseases and the development of biological agents have radically changed the treatment paradigm for severe rheumatoid arthritis. Several tumour necrosis factor (TNF)-α inhibitors are available for clinical use, relieving symptoms and reducing the likelihood of relapse in patients not responding successfully to disease-modifying antirheumatic drugs; however, there are limited data regarding the safety of, in particular the newest, TNF-α inhibitor. Drug-associated interstitial lung disease is a well-known serious and potentially fatal adverse effect of early TNF-α inhibitor use. Being a pegylated humanised Fab monoclonal antibody, certolizumab pegol (CZP) is different from other TNF-α inhibitors. In clinical trials it has been shown to be just as, or even more, efficacious in the treatment of rheumatoid arthritis in combination with methotrexate compared with some of the earlier TNF-α inhibitors [1]. According to the US Food and Drug Administration and the European Medicines Agency, there have been no severe non-infectious adverse lung effects of CZP use. However, a systematic review of the literature revealed two previous cases of CZP-associated interstitial lung disease, one with fatal outcomes [2, 3]. This is a report of a patient with rheumatoid arthritis who developed severe acute pneumonitis after treatment with CZP. The patient is a 72-year-old female who had suffered from severe erosive seropositive (rheumatoid factor and …