Respiratory medicine · 2026
Beyond corticosteroids: A systematic review and meta-analysis of novel therapies for hypersensitivity pneumonitis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Nabeh Omnia Azmy, Soliman Youssef Mohamed Amin, Elkorashy Reem Ibrahim, Akl Yosri, Elkholy Emad, Ahmed Mohamed Hassan Mennatullah Abdelhaleem, Ahmed Abd Elaleem Fatma Elzahraa, Gabr Rana Kamal El Said, Lewandowska Katarzyna B, Elmorsy Soha Aly
Аннотация
INTRODUCTION: Hypersensitivity pneumonitis (HP) is a complex immune-mediated interstitial lung disease triggered by inhaled antigens. While corticosteroids remain the mainstay of therapy, their benefit is limited in fibrotic HP. Several novel agents-including pirfenidone, nintedanib, rituximab, azathioprine, mycophenolate mofetil (MMF), leflunomide, and roflumilast-have been investigated as alternatives.
METHODS: This meta-analysis followed PRISMA guidelines and was registered on PROSPERO (CRD42023428070). Eligible studies included clinical and non-clinical trials assessing both traditional and novel therapies in HP. Primary outcomes were mean difference from baseline (MDB) and percentage change from baseline (PCB) in forced vital capacity (FVC%) and diffusing capacity for carbon monoxide (DLCO%). Meta-analyses were performed using fixed- and random-effects models, with heterogeneity assessed via I2. Sensitivity analyses and publication bias assessments were also conducted. Risk of bias was evaluated using CASP and RoB-2 tools.
RESULTS: Twenty-three studies comprising 975 patients (aged 39.3-83 years) were included. Rituximab, azathioprine, MMF, and corticosteroids showed non-significant pooled MDBs in FVC%, with MDB of -0.87 %, 2.49 %,1.96 %, and 2.03 %, respectively. For DLCO%, rituximab and MMF showed positive effects, with a MDB of 6.69 and 5.98, respectively, while azathioprine had minimal impact. Single-study analyses suggested that pirfenidone and nintedanib may stabilize lung function; their combination improved DLCO% but not FVC%. Leflunomide and roflumilast demonstrated promising effects in single reports.
CONCLUSION: Due to heterogeneity and limited high-quality evidence, definitive conclusions about novel therapies in HP remain elusive. However, rituximab and MMF showed promising results. Long-term randomized trials with standardized endpoints are needed to guide therapeutic decisions.
METHODS: This meta-analysis followed PRISMA guidelines and was registered on PROSPERO (CRD42023428070). Eligible studies included clinical and non-clinical trials assessing both traditional and novel therapies in HP. Primary outcomes were mean difference from baseline (MDB) and percentage change from baseline (PCB) in forced vital capacity (FVC%) and diffusing capacity for carbon monoxide (DLCO%). Meta-analyses were performed using fixed- and random-effects models, with heterogeneity assessed via I2. Sensitivity analyses and publication bias assessments were also conducted. Risk of bias was evaluated using CASP and RoB-2 tools.
RESULTS: Twenty-three studies comprising 975 patients (aged 39.3-83 years) were included. Rituximab, azathioprine, MMF, and corticosteroids showed non-significant pooled MDBs in FVC%, with MDB of -0.87 %, 2.49 %,1.96 %, and 2.03 %, respectively. For DLCO%, rituximab and MMF showed positive effects, with a MDB of 6.69 and 5.98, respectively, while azathioprine had minimal impact. Single-study analyses suggested that pirfenidone and nintedanib may stabilize lung function; their combination improved DLCO% but not FVC%. Leflunomide and roflumilast demonstrated promising effects in single reports.
CONCLUSION: Due to heterogeneity and limited high-quality evidence, definitive conclusions about novel therapies in HP remain elusive. However, rituximab and MMF showed promising results. Long-term randomized trials with standardized endpoints are needed to guide therapeutic decisions.