Safety and Effectiveness of Mycophenolate Mofetil in Interstitial Lung Diseases: Insights from a Machine Learning Radiographic Model.

Abstract

INTRODUCTION:

Treatment of interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis (IPF) often includes systemic corticosteroids. Use of steroid-sparing agents is amenable to avoid potential side effects.

METHODS:

Functional indices and high-resolution computed tomography (HRCT) patterns of patients with non-IPF ILDs receiving mycophenolate mofetil (MMF) with a minimum follow-up of 1 year were analyzed. Two independent radiologists and a machine learning software system (Imbio 1.4.2.) evaluated HRCT patterns.

RESULTS:

Fifty-five (n = 55) patients were included in the analysis (male: 30 [55%], median age: 65.0 [95% CI: 59.7-70.0], mean forced vital capacity %predicted [FVC %pred.] ± standard deviation [SD]: 69.4 ± 18.3, mean diffusing capacity of lung for carbon monoxide %pred. ± SD: 40.8 ± 14.3, hypersensitivity pneumonitis: 26, connective tissue disease-ILDs [CTD-ILDs]: 22, other ILDs: 7). There was no significant difference in mean FVC %pred. post-6 months (1.59 ± 2.04) and 1 year (-0.39 ± 2.49) of treatment compared to baseline. Radiographic evaluation showed no significant difference between baseline and post-1 year %ground glass opacities (20.0 [95% CI: 14.4-30.0] vs. 20.0 [95% CI: 14.4-25.6]) and %reticulation (5.0 [95% CI: 2.0-15.6] vs. 7.5 [95% CI: 2.0-17.5]). A similar performance between expert radiologists and Imbio software analysis was observed in assessing ground glass opacities (intraclass correlation coefficient [ICC] = 0.73) and reticulation (ICC = 0.88). Fourteen patients (25.5%) reported at least one side effect and 8 patients (14.5%) switched to antifibrotics due to disease progression.

CONCLUSION:

Our data suggest that MMF is a safe and effective steroid-sparing agent leading to disease stabilization in a proportion of patients with non-IPF ILDs. Machine learning software systems may exhibit similar performance to specialist radiologists and represent fruitful diagnostic and prognostic tools.

• Authors: Theodoros Karampitsakos, Christina Kalogeropoulou, Vasilios Tzilas, Ourania Papaioannou, Alexandra Kazantzi, Evangelia Koukaki, Matthaios Katsaras, Evangelos Bouros, Panagiota Tsiri, Georgios Tsirikos, Eirini Zarkadi, Nikolaos Ntoulias, Vasilina Sotiropoulou, Panagiotis Efthymiou, Serafeim Chrysikos, Elli Malakounidou, Fotios Sampsonas, Demosthenes Bouros, Argyrios Tzouvelekis
• Journal: Respiration; international review of thoracic diseases (Respiration) 2022 Vol. 101 Issue 3 Pg. 262-271 ISSN: 1423-0356 [Electronic] Switzerland
• PMID: 34592744 (Publication Type: Journal Article)
• Copyright: © 2021 S. Karger AG, Basel.

Chemical References

• Mycophenolic Acid

Topics

• Aged
• Female
• Humans
• Idiopathic Pulmonary Fibrosis (diagnostic imaging, drug therapy)
• Lung Diseases, Interstitial (diagnostic imaging, drug therapy)
• Machine Learning
• Male
• Middle Aged
• Mycophenolic Acid (adverse effects, therapeutic use)
• Vital Capacity