Glucocorticoids may confer adverse outcomes in patients with suspected IPF
There have been a substantial number of severe adverse events (SAE) and a faster decrease in forced vital capacity (FVC) in patients with possible idiopathic pulmonary fibrosis (posIPF) taking steroid therapy, a new study has shown.
Several prednisone-treated posIPF patients were nonresponders (68 percent), with >5-percent decline in FVC or death within 6 months from baseline. In addition, 90 percent of patients with radiographical presence of honeycombing were nonresponders.
On the other hand, six of seven patients with focal desquamative interstitial pneumonia-like reaction in surgical lung biopsy (SLB) who had stopped smoking for <5 years ago responded to prednisone, with <5-percent decrease in FVC.
In 32 patients with available FVC data, mean FVC decline was 8.7 percent (95 percent CI, 3.1–14.3 percent) and 20 percent (9.4–31.1 percent) before and after treatment, respectively. A total of 12 SAE and five deaths occurred within the first 3 months on prednisone (at dosage >0.3 mg/kg/day).
The investigators retrospectively analysed a multicentre cohort of 59 prednisone-treated posIPF patients to assess outcomes of immunomodulatory treatment. Prednisone starting dose was 0.5 mg/kg/day and tapered to 0.15 mg/day/kg over 6 months. FVC and SAE, defined as death or hospital admissions, were the outcome measures.
“The diagnostic classification of posIPF is characterized by a radiological pattern of inconsistent usual interstitial pneumonia (UIP) on high‐resolution computed tomography scan and a UIP pattern in SLB,” the investigators said.
“The evidence base to guide treatment for patients with posIPF is lacking; the clinician must choose between observation, treatment with immunomodulatory agents or antifibrotic agents,” they added.