Manchester, UK—Widely prescribed drugs for a range of conditions appear to have a previously unsuspected dark side, according to a new study that found that toxic effects on the lungs are more prevalent than previously suspected.

The report in the Journal of Clinical Medicine urges more awareness of potential risk to respiratory systems with use of prescription drugs. University of Manchester–led researchers identified 27 drugs—most of which were successful in treating conditions such as arthritis, cancer, and cardiovascular disease—as problematic based on a review of 156 trials involving 6,200 patients.

The study was conducted as part of a project funded by the European Union and the European pharmaceutical industry’s Innovative Medicine Initiative, which seeks to develop imaging techniques for the management of drug-induced interstitial lung disease (DIILD).

Background information in the article notes that, while DILD occurs as a result of numerous medications, it usually becomes apparent only after marketing authorization. The current study sought to evaluate and synthesize literature on DIILD.

Part of the problem, according to the study team, is that the majority, 78%, of the papers were of low or very low quality in terms of addressing issues about lung damage. “Thus, it was not possible to perform a meta-analysis, and descriptive review was undertaken instead,” the researchers explained.

Available results suggest that DIILD incidence rates varied between 4.1 and 12.4 cases/million/year, accounting for 3% to 5% of prevalent ILD cases.

The most common causes were cancer drugs, followed by rheumatology drugs, amiodarone, and antibiotics, according to the researchers.

“The radiopathological phenotype of DIILD varied between and within agents, and no typical radiological pattern specific to DIILD was identified,” the study noted. “Mortality rates of over 50% were reported in some studies. Severity at presentation was the most reliable predictor of mortality.”

In terms of treatment for symptoms such as breathing difficulties, inflammation, and fibrosis, glucocorticoids (GCs) were commonly used, although no prospective studies examined their effect on outcome.

“Overall high-quality evidence in DIILD is lacking, and the current review will inform larger prospective studies to investigate the diagnosis and management of DIILD,” study authors emphasized.

“Though this area is not well researched, we can say that the side effects of drugs on the lung are much more widespread than previously thought,” pointed out coauthors John Waterton, PhD, of the University of Manchester. “We do know it affects a considerable number of people, which is why we want to develop better imaging tests to pick up any lung problems before they become serious.”

Researcher Nazia Chaudhuri, MB ChB, PhD, honorary senior lecturer at The University of Manchester and a consultant physician at Wythenshawe Hospital, added that health professionals “need to be aware and vigilant to the possible lung toxicities and harm that can be caused by some drugs. With newer drugs coming on the market this is an increasing yet under recognized problem and we need better ways of detecting these side effects before they cause harm.”

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