{
  "abstract": "BackgroundAcute exacerbation of rheumatic disease-associated interstitial lung disease (AE-RD-ILD) is life-threatening and is commonly managed with high-dose corticosteroids; however, no standardised evidence-based regimen has been established, particularly regarding adjunctive immunosuppressive therapy. We evaluated the effectiveness and safety of tocilizumab, an interleukin-6 receptor inhibitor, in hospitalised patients with AE-RD-ILD.MethodsIn this single-centre ambispective observational cohort study conducted between January 2023 and December 2024, patients treated with tocilizumab (n=26) were compared with controls receiving corticosteroid-based conventional immunosuppression without tocilizumab (n=36). The primary outcome was investigator-defined objective composite clinical response (CR) at 24 weeks. Secondary outcomes included glucocorticoid exposure, oxygen discontinuation, radiological change, new acute exacerbation (AE) events, death or lung transplantation, and safety.ResultsThe 24-week CR rate was higher with tocilizumab than in controls (80.8% [21/26] vs. 13.9% [5/36], p<0.001), with a risk ratio of 5.82 (95% CI 2.52-13.40) and an adjusted hazard ratio of 10.43 (95% CI 3.71-29.28); estimates were consistent in sensitivity analyses addressing competing risks, guarantee-time bias and additional confounders. Tocilizumab was associated with lower cumulative prednisone dose (3955 vs. 5005 mg, p=0.016), lower minimum maintenance dose (10.0 vs. 15.0 mg/day, p<0.001), more frequent oxygen discontinuation (76.9% vs. 30.6%, p<0.001), and greater CT-assessed reduction in ILD extent (20% vs. 15%, p=0.045). New AE events and death or lung transplantation were numerically less frequent but not statistically significant. At least one infection occurred in 23.1% of tocilizumab-treated patients and 38.9% of controls (p=0.272). During longer follow-up, seven controls subsequently switched to tocilizumab because of recurrent or progressive respiratory disease.ConclusionsTocilizumab was associated with higher short-term objective composite clinical response and improved respiratory and glucocorticoid-sparing outcomes in AE-RD-ILD. These findings support further evaluation of interleukin-6 receptor blockade in selected patients, while the non-randomised design and investigator-defined endpoint require cautious interpretation. Because the cohort was predominantly composed of patients with anti-synthetase-spectrum disease, the findings primarily apply to this phenotype and should not be extrapolated to RA-ILD, SSc-ILD or other RD-ILD subtypes without caution.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "Original Research",
  "arxiv": null,
  "author_total": 14,
  "authors": [
    {
      "name": "Wenwen Xu"
    },
    {
      "name": "Yiyangzi Ma"
    },
    {
      "name": "Danting Zhang"
    },
    {
      "name": "Wanlong Wu"
    },
    {
      "name": "Shuhui Sun"
    },
    {
      "name": "Ruru Guo"
    },
    {
      "name": "Zhiwei Chen"
    },
    {
      "name": "Yakai Fu"
    },
    {
      "name": "Jie Chen"
    },
    {
      "name": "Kaiwen Wang"
    },
    {
      "name": "Xiaodong Wang"
    },
    {
      "name": "Yanwei Lin"
    },
    {
      "name": "Shuang Ye"
    },
    {
      "name": "Fang Du"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/e36vfx2973dg1.bib",
  "cited_by": 0,
  "doi": "10.3389/fimmu.2026.1985513",
  "fulltext_url": null,
  "id": "e36vfx2973dg1",
  "issns": [
    "1664-3224"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1985513",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "feed-journal",
      "biology/immunology"
    ]
  ],
  "openalex": null,
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-11-04",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/e36vfx2973dg1.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T06:20:39Z",
      "native_id": "10.3389/fimmu.2026.1985513",
      "source": "feed-frontiers",
      "url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1985513"
    },
    {
      "first_seen": "2026-11-04T12:21:26Z",
      "native_id": "10.3389/fimmu.2026.1985513",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fimmu.2026.1985513/full"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "feed-journal:biology/immunology",
      "subfield": "immunology"
    }
  ],
  "title": "Tocilizumab for acute exacerbation of rheumatic disease-associated interstitial lung disease: a real-world comparative cohort study",
  "title_text": "Tocilizumab for acute exacerbation of rheumatic disease-associated interstitial lung disease: a real-world comparative cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T00:21:18Z",
  "url": "https://research.draconitic.com/paper/e36vfx2973dg1",
  "venue": "Frontiers in Immunology",
  "versions": []
}