Pulse versus non‐pulse corticosteroid therapy in patients with acute exacerbation of idiopathic pulmonary fibrosis

• Published in: Respirology (Carlton, Vic.) Vic.), 2024-03, Vol.29 (3), p.235-242
• Main Authors: Hyung, Kwonhyung, Lee, Jong Hyuk, Kim, Joong‐Yub, Choi, Sun Mi, Park, Jimyung
• Format: Article
• Language: English
• Subjects: acute exacerbation; cohort study; Corticosteroids; Fibrosis; glucocorticoid; idiopathic pulmonary fibrosis; Lung diseases; Methylprednisolone; Patients; Pulmonary fibrosis; pulse corticosteroid therapy symptom flare up; Steroids; Survival
• ISSN: 1323-7799; 1440-1843; 1440-1843
• DOI: 10.1111/resp.14643

Background and Objective Corticosteroids are commonly used for the treatment of acute exacerbation of idiopathic pulmonary fibrosis (AE‐IPF); however, the optimal initial dose of corticosteroids remains uncertain due to a lack of sufficient evidence. We evaluated whether the administration of a pulse dose of corticosteroids resulted in improved survival outcomes compared with conventional non‐pulse dose of corticosteroids. Methods We retrospectively analysed 238 patients with AE‐IPF treated with corticosteroids at a tertiary referral hospital between January 2013 and December 2021. Based on whether a pulse dose of corticosteroids (methylprednisolone of ≥250 mg/day or equivalent) was administered within 7 days of hospitalization for AE‐IPF, the patients were divided into the pulse and non‐pulse regimen groups. The survival outcomes were compared between the two groups using multivariable regression and propensity score‐matched analyses. Results Among the 238 patients, 59 patients received pulse dose of corticosteroids, whereas 179 patients received conventional non‐pulse dose of corticosteroids. After adjusting for the confounding factors related to the baseline clinical and radiographic severity, compared with the conventional non‐pulse regimen, the pulse regimen of corticosteroids did not reduce the risk of mortality at the 3‐month (aHR 0.84, 95% CI 0.45–1.38) or 12‐month (aHR 0.96, 95% CI 0.60–1.25) follow‐ups. Propensity score‐matched analysis revealed similar results. Conclusion The survival outcomes of patients with AE‐IPF who received a pulse dose of corticosteroids did not differ from those of patients who received conventional non‐pulse dose of corticosteroids. Further prospective studies are required to establish the optimal initial dose of corticosteroids for the treatment of AE‐IPF. A pulse dose of corticosteroids did not improve survival outcome of acute exacerbation of IPF when compared with conventional non‐pulse dose of corticosteroids.