Browse ATS 2021 Abstracts

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ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.

Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.

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Malignancy Risk Associated with Mycophenolate Mofetil and Azathioprine in Patients with Fibrotic Interstitial Lung Disease

Session Title
A2 - A002 GENES, ENVIRONMENT, AND TREATMENT: CHARACTERIZING RISK IN ILD
Abstract
A1009 - Malignancy Risk Associated with Mycophenolate Mofetil and Azathioprine in Patients with Fibrotic Interstitial Lung Disease
Author Block: S. D. Lok1, A. W. Wong2, G. P. Cox3, C. D. Fell4, J. H. Fisher5, A. S. Gershon6, A. J. Halayko7, N. Hambly8, N. Khalil9, M. R. Kolb10, H. Manganas11, V. Marcoux12, J. Morisset13, D. Assayag14, M. Sadatsafavi15, S. Shapera16, T. To17, P. Wilcox2, C. J. Ryerson18, K. A. Johannson19; 1University of Saskatchewan, Saskatoon, SK, Canada, 2University of British Columbia, Vancouver, BC, Canada, 3St Josephs Health Care, Hamilton, ON, Canada, 4South Health Campus, University of Calgary, Calgary, AB, Canada, 5University Health Network, Toronto, ON, Canada, 6Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 7Physiology / Internal Medicine (Respirology), University of Manitoba, Winnipeg, MB, Canada, 8Respirology, McMaster University, Hamilton, ON, Canada, 9The University of British Columbia, Vancouver, BC, Canada, 10Mc Master Univ, Hamilton, ON, Canada, 11Medicine, CHUM, Montreal, QC, Canada, 12Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada, 134300 Saint-Hubert, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada, 14Medicine, McGill University, Montreal, QC, Canada, 15Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada, 16Medicine, University of Toronto, Toronto, ON, Canada, 17Hosp for Sick Children, Toronto, ON, Canada, 18Dept Medicine, University of British Columbia, Vancouver, BC, Canada, 19Medicine, University of Calgary, Calgary, AB, Canada.
Rationale Mycophenolate Mofetil (MMF) and Azathioprine (AZA) are immunomodulatory drugs used in the treatment of hypersensitivity pneumonitis (HP) and connective tissue disease-associated interstitial lung disease (CTD-ILD). Both hematologic and solid tumor malignancies have been reported as adverse outcomes of MMF or AZA therapy. However, these attributable risks are derived from the organ transplant population, in which malignancy risk is well established, and may not generalize to patients with ILD. The objective of this study was to characterize the malignancy risk associated with MMF or AZA therapy in patients with CTD-ILD or HP. Methods A retrospective observational cohort study was conducted using data from the Canadian Registry for Pulmonary Fibrosis (CARE-PF). All patients with CTD-ILD or HP were included, stratified by whether they had been treated with MMF (MMF group), AZA (AZA group), or neither (untreated group), with treatment defined as use of the specified medication for at least 3 months. Patients were excluded if they ever received cyclophosphamide or rituximab or had missing medication data. Those who switched between MMF and AZA were grouped by the drug they received for the longest duration. The outcome of interest was diagnosis of any malignancy. Prior malignancy was defined as malignancy diagnosed prior to drug treatment in the treated groups or prior to the first ILD clinic appointment in the untreated group. Censoring occurred at last known clinic date, lung transplantation, or date of death. Malignancy rate is described as the annual rate of cancer incidence in each treatment group for the duration of follow-up. Results Of 3883 registry patients, 1157 met inclusion criteria (Table 1), with median follow-up of 3.1 (IQR=3.8) years. The frequency of incident malignancy was 32/467 (6.9%) in the MMF group, 8/151 (5.3%) in the AZA group, and 45/539 (8.3%) in the untreated group. The annual incidence of malignancy per person, per treatment period (malignancy/person/year) was 0.022, 0.007, and 0.022 for the MMF, AZA, and untreated groups, respectively. There were no cases of lymphoma in either the MMF or AZA groups. Conclusion We did not identify an increased risk of malignancy in patients with CTD-ILD or HP treated with MMF and/or AZA, compared to untreated patients, although the higher rates of prior malignancy in the untreated category may have influenced pharmacotherapeutic decisions. These data support the short-term safety of these medications in patients with CTD-ILD and HP and inform the importance of characterizing risks in specific patient populations.