Certolizumab pegol
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First report of interstitial lung disease in an elderly patient: case report A 71-year-old woman with rheumatoid arthritis developed interstitial lung disease during treatment with certolizumab pegol. The woman received eight doses of certolizumab pegol every 2 weeks [dose and route not stated] along with methotrexate, aspirin, tolterodine and simvastatin. She presented with a 5-day history of dyspnoea and dry cough. Physical examination revealed fever, a RR of 34 breaths/min, HR of 92 bpm, BP of 124/88mm Hg and oxygen saturation of 88%. Widespread fine inspiratory crepitations were heard upon auscultation and chest X-ray showed patchy consolidation involving both lung fields. High resolution CT scan showed extensive bilateral ground glass shadowing involving all lobes, suggesting a noninfectious pathology. No evidence of active infection was found upon analysis of bronchoalveolar lavage fluid. Certolizumab pegol and methotrexate were withdrawn upon admission, and the woman initially received prednisolone, clarithromycin and amoxicillin. She subsequently received methylprednisolone. Extensive microbiological investigations were negative, except for the detection of low-level colonisation of Pneumocystis jirovecii, judged to be clinically insignificant. Her symptoms did not progress once treatment was started; she was discharged on home oxygen, prednisolone, lansoprazole, calcium/colecalciferol and alendronic acid. At 2 months follow-up, her symptoms had not improved. Pearce F, et al. Interstitial lung disease following certolizumab pegol. Rheumatology 51: 578-580, No. 3, Mar 2012. Available from: URL: http:// 803069976 dx.doi.org/10.1093/rheumatology/ker309 - United Kingdom
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of interstitial lung disease associated with certolizumab. The WHO ADR database contained three reports of interstitial lung disease associated with certolizumab.
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Reactions 5 May 2012 No. 1400
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