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- Title
High-dose prednisolone after intravenous methylprednisolone improves prognosis of acute exacerbation in idiopathic interstitial pneumonias.
- Authors
Arai, Toru; Tachibana, Kazunobu; Sugimoto, Chikatoshi; Inoue, Yasushi; Tokura, Sayoko; Okuma, Tomohisa; Akira, Masanori; Kitaichi, Masanori; Hayashi, Seiji; Inoue, Yoshikazu
- Abstract
ABSTRACT Background and objective Acute exacerbation ( AE) of idiopathic pulmonary fibrosis ( IPF) ( AE-IPF) is a poor prognostic disorder. AE is also reported to occur in other idiopathic interstitial pneumonias ( IIPs). There are limited data available regarding the effectiveness of treatment for AE-IIPs. The objective of this study was to clarify the prognostic impact of the initial dose of prednisolone ( PSL) for treating AE-IIPs. Methods Eighty-five patients with AE-IIPs, diagnosed according to the criteria of the Japanese Respiratory Society, were enrolled in this study ( IPF/non- IPF: 63/22 patients) from 2004 to 2013. We performed multivariate Cox proportional hazard regression analysis to identify poor prognostic factors. HRCT patterns at the onset of AE-IIPs were classified as diffuse or non-diffuse. We evaluated the prognostic significance of the initial dose of PSL by adjusting for other prognostic factors. Results Median survival time ( MST) after AE-IIPs diagnosis was 49 days. MST of AE-IPF and AE-non- IPF was 39 and 49 days, respectively. A diffuse HRCT pattern, lower serum IgG and higher serum surfactant protein-D at AE diagnosis, long-term oxygen therapy ( LTOT) before AE and positive pressure ventilation ( PPV) use for AE were significant poor prognostic factors for all patients, as were LTOT before AE and lower serum IgG for no- PPV patients. High-dose PSL ≥ 0.6 mg/kg was a significant prognostic factor for no- PPV patients after adjusting for other prognostic factors. Conclusion We concluded that a dose of PSL ≥ 0.6 mg/kg after i.v. high-dose methylprednisolone therapy should be recommended for the treatment of AE-IIPs.
- Subjects
IDIOPATHIC interstitial pneumonias; PREDNISOLONE; METHYLPREDNISOLONE
- Publication
Respirology, 2017, Vol 22, Issue 7, p1363
- ISSN
1323-7799
- Publication type
Article
- DOI
10.1111/resp.13065