Citation

BibTex format

@article{Pugashetti:2026:ajrccm/aamag362,
author = {Pugashetti, JV and Jee, AS and Yu, AR and Hammoud, N and Chua, F and Yazbeck, L and Lee, CT and Liu, GY and Adams, TN and Adegunsoye, A and Wolters, PJ and Khanna, D and Strek, ME and Oldham, JM and Molyneaux, PL and Newton, CA},
doi = {ajrccm/aamag362},
journal = {American Journal of Respiratory and Critical Care Medicine},
pages = {2493--2503},
title = {Mycophenolate and azathioprine in fibrotic interstitial lung disease},
url = {http://dx.doi.org/10.1093/ajrccm/aamag362},
volume = {212},
year = {2026}
}
Download

RIS format (EndNote, RefMan)

TY  - JOUR
AB  - RationaleImmunosuppression is routinely used for non–idiopathic pulmonary fibrosis (IPF) interstitial lung diseases (ILDs), despite limited trial evidence and unclear impact on long-term outcomes.ObjectivesTo evaluate whether mycophenolate or azathioprine improves 3-year transplant-free survival and lung function trajectory in fibrotic ILD, including non-IPF idiopathic interstitial pneumonia (IIP), fibrotic hypersensitivity pneumonitis (fHP), and connective tissue disease (CTD)–associated ILD.MethodsWe employed a clone-censor-weighting framework to emulate a randomized controlled trial in this multicenter retrospective study. Each patient was cloned and assigned to immunosuppression initiation within 6 months of enrollment or no initiation strategies and censored when the assigned strategy deviated from observed treatment. Stabilized inverse probability treatment and censoring weights were used.MeasurementsThe primary endpoint was 3-year transplant-free survival assessed with weighted Cox models across treatment strategies. Weighted generalized estimating equations were used to model lung function trajectory.Main resultsAmong 2270 included patients, 18% (186/1022) with non-IPF IIP, 30% (162/544) with fHP, and 31% (221/704) with CTD-ILD were initiated on immunosuppression within 6 months. Immunosuppression was not associated with improved survival within any ILD subtype but was associated with worse survival in non-IPF IIP (hazard ratio [HR] = 1.38; 95% CI, 1.04-1.84) and fHP (HR = 1.62; 95% CI, 1.09-2.40). Immunosuppression was not associated with differential lung function trajectory within any ILD subtype.ConclusionsIn this study, immunosuppression initiation showed no evidence of benefit for 3-year transplant-free survival or lung function and was associated with higher mortality in select fibrotic ILD subtypes. Prospective randomized controlled trials are needed to inform patient care.
AU  - Pugashetti,JV
AU  - Jee,AS
AU  - Yu,AR
AU  - Hammoud,N
AU  - Chua,F
AU  - Yazbeck,L
AU  - Lee,CT
AU  - Liu,GY
AU  - Adams,TN
AU  - Adegunsoye,A
AU  - Wolters,PJ
AU  - Khanna,D
AU  - Strek,ME
AU  - Oldham,JM
AU  - Molyneaux,PL
AU  - Newton,CA
DO  - ajrccm/aamag362
EP  - 2503
PY  - 2026///
SN  - 1073-449X
SP  - 2493
TI  - Mycophenolate and azathioprine in fibrotic interstitial lung disease
T2  - American Journal of Respiratory and Critical Care Medicine
UR  - http://dx.doi.org/10.1093/ajrccm/aamag362
UR  - https://doi.org/10.1093/ajrccm/aamag362
VL  - 212
ER  -
Download