What is your approach in a patient who develops interstitial lung disease while on anti-TNF therapy?

I would stop the TNF antagonist and never use this class of drugs again in the patient. In fact, I generally stay away from TNF antagonists in RA patients with any sign of pre-existing lung disease. The experience of Nakashita et al., PMID 25125479 is highly informative and parallels my experience, fortunately uncommon.