Table 3. Treatment strategies for AS specific ILD.
Medications | Suggested dose | Baseline testing | Test frequency | Major adverse effects |
---|---|---|---|---|
Corticosteroids | Prednisone: 1 mg/kg daily | Bone density | After 1 year, then every 2–3 years if stable or more frequently if bone density decreased | Hyperglycemia |
Upper limit: 60–80 mg daily | Hemoglobin A1c | Hypertension | ||
Osteoporosis | ||||
Cataracts | ||||
Sleep disturbances | ||||
Azathioprine | 1.0–2.0 mg/kg/day | CBC, CMP, thiopurine S-methyltransferase (TPMT), pregnancy | Monthly, then every 3 months | BM suppression |
Hepatotoxicity, Pancreatitis | ||||
Mycophenolate | 500–1,500 mg PO BID | CBC, CMP, pregnancy | Monthly, then every 3 months | BM suppression |
GI symptoms (e.g., diarrhea) | ||||
Increase miscarriage & congenital abnormalities | ||||
Tacrolimus | 1 mg twice daily (target trough levels 5–8 ng/mL) | CBC, CMP, pregnancy test | Monthly | CKD |
Hypertension | ||||
Tremors | ||||
Cyclophosphamide | IV CYC monthly × 6 months | CBC, CMP, pregnancy, hepatitis panel, T-spot, urinalysis, age-appropriate cancer screening | Monthly ×1 year, then every 3 months | Malignancy, Cytopenias, Hemorrhagic cystitis, Sterility |
Rituximab | 1 gm × 2 doses, 2 weeks apart | CBC, CMP, HIV, hepatitis panel, T-spot test | Prior to each infusion | Infection, Neutropenia, Infusion reaction |
AS, anti-synthetase syndrome; ILD, interstitial lung disease.