Methylprednisolone plus prednisone, tacrolimus offers multidimensional therapeutic benefit in CTD-ILD
Two courses of pulse dose methylprednisolone therapy followed by prednisolone and oral tacrolimus appear to be safe and effective in patients with connective tissue disease‐related interstitial lung disease (CTD-ILD), a recent study has shown.
A total of 26 ILD patients with underlying CTD diagnoses were included (11 with rheumatoid arthritis, nine with dermatomyositis, four with Sjögren's syndrome and two others).
From baseline to 12 months, forced vital capacity (FVC; 77.8–94.6 percent; p<0.001), diffusing capacity of the lung for carbon monoxide (DLCO; 66.1–75.1 percent; p<0.001), 6‐min walk distance (6MWD; 530–568 m; p=0.02), lowest oxygen saturation on pulse oximetry (SpO2; 85–89 percent; p=0.01), modified Medical Research Council (MMRC; 1.3–0.8; p=0.01) and St George's Respiratory Questionnaire (SGRQ; 38–21; p<0.001) significantly improved with the combined therapy.
Only one patient discontinued therapy due to an adverse event during the study period. None of the patients had a life-threatening adverse event attributed to the combined therapy.
This retrospective case series sought to examine the multidimensional therapeutic benefit and tolerability of the combined therapy for the initial treatment of patients with CTD-ILD.
The authors identified consecutive CTD-ILD patients treated with tacrolimus plus intravenous IV methylprednisolone (1,000 mg 3 days a week for 2 weeks) followed by low-dose prednisolone (10 mg/day). They evaluated the efficacy and tolerability including lung physiology, exercise capacity, exercise oxygen desaturation, MMRC and SGRQ.
“Corticosteroids and immunosuppressive agents are considered mainstays of therapy for CTD‐ILD; however, tacrolimus with corticosteroid therapy has not been fully investigated,” the authors said.