Systemic corticosteroids in fibrotic lung disease: a systematic review and meta-analysis

• Published in: BMJ open respiratory research 2023-12, Vol.10 (1), p.e002008
• Main Authors: Pitre, Tyler, Kawano-Dourado, Leticia, Kachkovski, George V, Leung, Darren, Leung, Gareth, Desai, Kairavi, Zhai, Chunjuan, Adams, Wendy, Funke-Chambour, Manuela, Kreuter, Michael, Stewart, Iain, Ryerson, Christopher J, Jenkins, Gisli, Zeraatkar, Dena
• Format: Article
• Language: English
• Subjects: Bias; Clinical Epidemiology; Clinical medicine; Cohort analysis; Decision making; Interstitial Fibrosis; Interstitial Lung Disease; Lung diseases; Mortality; Patients; Performance evaluation; Pulmonary fibrosis; Steroids; Systemic disease and lungs
• ISSN: 2052-4439; 2052-4439
• DOI: 10.1136/bmjresp-2023-002008

ObjectivesWe aimed to assess the available evidence for corticosteroids in fibrotic interstitial lung disease (fILD) to inform the randomised embedded multifactorial adaptive platform ILD.DesignSystematic review and meta-analysis.Data sourcesWe searched Embase, Medline, Cochrane CENTRAL and Web of Science databases from inception to April 17 2023.Eligibility criteriaWe included studies that compared corticosteroids with standard care, placebo or no treatment in adult patients with fILD.Data extraction and synthesisWe report on the change in forced vital capacity (FVC) and mortality. We used random-effects meta-analysis to estimate relative risk (RR) for dichotomous outcomes, and mean difference (MD) and standardised MDs for continuous outcomes, with 95% CIs.ResultsOf the 13 229 unique citations identified, we included 10 observational studies comprising 1639 patients. Corticosteroids had an uncertain effect on mortality compared with no treatment (RR 1.03 (95% CI 0.85 to 1.25); very low certainty evidence). The effect of corticosteroids on the rate of decline in FVC (% predicted) was uncertain when compared with no treatment (MD 4.29% (95% CI −8.26% to 16.83%); very low certainty evidence). However, corticosteroids might reduce the rate of decline in FVC in patients with non-idiopathic pulmonary fibrosis (IPF) fILD (MD 10.89% (95% CI 5.25% to 16.53%); low certainty evidence), while an uncertain effect was observed in patients with IPF (MD −3.80% (95% CI −8.94% to 1.34%); very low certainty evidence).ConclusionsThe current evidence on the efficacy and safety of corticosteroids in fILD is limited and of low certainty. Randomised trials are needed to address this significant research gap.