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Early corticosteroid dose tapering in patients with acute exacerbation of idiopathic pulmonary fibrosis

Anan, Keisuke 京都大学 DOI:10.14989/doctor.k24808

2023.05.23

概要

Idiopathic pulmonary fibrosis (IPF), the most common
idiopathic interstitial pneumonia (IP), is characterized by
chronic progressive lung fibrosis. IPF has a poor prognosis, with which 5–15% of patients experience acute exacerbation (AE) every year, and AE-IPF has been associated
with in-hospital mortality of 50–60%. [1, 2] Although
several treatments for AE-IPF exist, [3, 4] none have been
proven to be effective, and there is an urgent need for an
effective treatment.
Corticosteroids are the most commonly used treatment for AE-IPF. Although no randomized controlled
trials have investigated their efficacy for treating AEIPF, their use has been weakly recommended in international guidelines, [5] and they are widely accepted as
the standard treatment for AE-IPF. When corticosteroids
are used to treat AE-IPF, their dose is often gradually
tapered. [4]
However, there is no consensus on the regimen for corticosteroid dose tapering in patients with AE-IPF. Early
tapering of corticosteroid dose has been found to reduce
side effects without worsening prognosis in patients
requiring systemic corticosteroids for treating other diseases. [6–9] However, the American Thoracic Society/
European Respiratory Society/Japanese Respiratory Society/Latin American Thoracic Association guidelines for
IPF do not specify any method for tapering steroids in
patients with AE-IPF. [5] Furthermore, we believe that no
study has been conducted on this topic in patients with
AE-IPF. Therefore, there is a need to investigate the association between the steroid tapering method and prognosis in patients with AE-IPF.
This study aimed to investigate the relationship
between early tapering of corticosteroid dose and shortterm AE-IPF prognosis using data from two cohorts. We
hypothesized that early tapering of corticosteroid dose
will be associated with a better AE-IPF prognosis than
non-early tapering.
Methods
This study has been reported in accordance with the
Strengthening the Reporting of Observational Studies in
Epidemiology [10] and Reporting of studies Conducted
using Observational Routinely collected health Data [11]
statements (Table S1). ...

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