The edition · Pulmonology
Immunosuppression showed no benefit and possible harm in some fibrotic lung diseases; severe asthma biologics worked as well in smokers in a registry analysis
Two observational analyses that question familiar habits, a small crossover study of ondansetron in ARDS, a chemotherapy-sparing EGFR-mutant lung cancer regimen, and a pooled analysis of HIV-associated pulmonary hypertension.
The edition in brief
A clone-censor-weighting trial emulation of 2,270 patients with fibrotic interstitial lung disease found that starting mycophenolate or azathioprine within 6 months was not linked to better 3-year transplant-free survival in any subtype and was linked to worse survival in non-IPF idiopathic interstitial pneumonia (HR 1.38, 95% CI 1.04 to 1.84) and fibrotic hypersensitivity pneumonitis (HR 1.62, 1.09 to 2.40); lung function trajectories did not differ. In the ERS SHARP registry (3,876 adults with severe asthma), improvements in control, exacerbations, quality of life and steroid use after a year of biologic therapy were of similar magnitude in never-, ex- and current smokers. In nine patients with ARDS on pressure support, intravenous ondansetron lowered inspiratory effort in a non-randomised crossover study. A single-arm phase 2 trial (AMAZE-lung) of amivantamab, lazertinib and bevacizumab after third-generation EGFR inhibitor progression had a 33% 12-week response rate in 60 patients. A meta-analysis of 12 cohorts (537 people) found only 64% of people with HIV-associated pulmonary arterial hypertension received targeted therapy at diagnosis. A pearl on checking basics before escalating asthma therapy closes the edition.
Mycophenolate and azathioprine in fibrotic ILD: no survival benefit, possible harm in two subtypes
Think twice before starting mycophenolate or azathioprine in fibrotic non-IPF ILD; observational data show no benefit and a possible signal of harm.
Ondansetron lowered respiratory effort in a small crossover study of ARDS
Ondansetron reduced respiratory drive in a nine-patient study; it is a research signal, not a treatment for ARDS.
AMAZE-lung: a chemotherapy-sparing triplet after third-generation EGFR inhibitor progression
This regimen is a promising chemotherapy-sparing option from a phase 2 single-arm trial; use it only through a trial or specialist pathway.
HIV-associated pulmonary arterial hypertension: survival improved, but only 64% got targeted therapy at diagnosis
In people with HIV and confirmed PAH, refer to a pulmonary hypertension centre to consider targeted therapy.
Before calling asthma severe, check the basics
Check diagnosis, adherence, technique and exposures before labelling asthma severe or escalating therapy.
Biologics worked as well in smokers and ex-smokers with severe asthma as in never-smokers
Consider biologic therapy for smokers and ex-smokers with severe asthma on the same criteria as others, alongside active cessation support.
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