Systemic autoimmune disease in asbestosis rapidly responding to anti-interleukin-1beta antibody canakinumab: a case report

Our plain-English summary of Systemic autoimmune disease in asbestosis rapidly responding to anti-interleukin-1beta antibody canakinumab: a case report, by L. Niccoli, E. Cassarà, O. Kaloudi, et al (BMC Musculoskeletal Disorders, 2015).

The study

• Authors: L. Niccoli, E. Cassarà, O. Kaloudi, C. Nannini, M. Romagnoli, F. Cantini
• Journal: BMC Musculoskeletal Disorders
• Published: 2015;16:146
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Asbestosis is characterized by lung and pleural fibrosis and by immune system dysregulation, with autoantibody production and systemic immune-mediated disease. No specific therapies are available for asbestosis. Recently, the pivotal pathogenic role exerted by interleukin-1beta has been recently reported.

Case Presentation: We treated with anti-interleukin 1 beta targeted antibody canakinumab a 67 year old man with asbestosis and long lasting systemic autoimmune features. A dramatic improvement in clinical manifestations was observed at 1 week after the first injection, with complete clinical remission at 4 months.

Conclusion: This case suggests new perspectives for the treatment of asbestosis and its systemic features.

In plain English

This was a case report about one patient treated at a hospital rheumatology division in Prato, Italy. A 67-year-old man who had worked for 35 years as a quarryman in different Italian mines came to the authors' center in May 2014 with a 12-year history of low-grade fever and joint pain. He had received several diagnoses, and his symptoms flared when his prednisone dose was reduced to 5 mg/day. He had developed osteoporosis with spinal fractures, and diabetes. A lung scan showed pulmonary fibrosis with pleural plaques suggesting asbestosis. The authors diagnosed mild asbestosis with prominent asbestos-induced systemic autoimmune disease features. He received canakinumab, an antibody that blocks interleukin-1beta, at 150 mg every 8 weeks. After 7 days he had no symptoms, and blood markers of inflammation had fallen. At 4 months he was still in clinical remission, and the treatment was well tolerated. The authors concluded the case may suggest a new treatment approach. They stated that it gives no indication of effects on lung fibrosis and does not allow definitive conclusions.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 67-year-old man seen at the Rheumatology Division, Hospital of Prato, Italy, starting in May 2014, with a 12-year history of low-grade fever, symmetric joint pain and occasional mild joint swelling
• Exposure: Occupational: 35 years working as a quarryman in different Italian mines. The article does not name the asbestos fiber type or give exposure levels. The treatment studied was subcutaneous canakinumab, 150 mg every 8 weeks.
• Main results:
  • Before canakinumab, the patient's symptoms had flared when his prednisone dose was reduced to 5 mg/day over the previous 12 years
  • High-resolution CT of the patient's lungs showed pulmonary fibrosis with pleural plaques suggesting asbestosis
  • The authors diagnosed mild asbestosis with prominent asbestos-induced systemic autoimmune disease features
  • The patient's inflammation markers after steroids were stopped and before canakinumab: ESR 56 mm/h and CRP 7.75 mg/dl
  • At the 7-day visit after starting canakinumab, the patient was symptom-free, and his ESR and CRP had fallen to 36 mm/h and 1.6 mg/dl
  • After 4 months, the patient was still in clinical remission, with ESR 12 mm/h, CRP 0.19 mg/dl, and a lower ANA titer of 1/320 (down from 1/1280)
  • The therapy was well tolerated in this patient, with no adverse events or side effects
• The authors' conclusion: The authors concluded that the result in this patient seems to support the reported role of the inflammasome and IL-1beta, and may suggest a new approach to treating the systemic autoimmune features of asbestosis and possibly lung involvement
• Limitations the authors state:
  • The case gives no indication of how anti-IL-1beta therapy affects progression of lung fibrosis
  • The case does not allow definitive conclusions to be drawn

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Fibrosis.

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