Corticosteroids in acute exacerbations of idiopathic interstitial pneumonias: Time to debate – Reply

Abstract

See http://onlinelibrary.wiley.com/doi/10.1111/resp.13279/full

Is corticosteroid use truly not associated with improved outcomes in AE‐IPF?

“…Hence, we compared the survival of AE-IPF patients treated with low doses of prednisolone (<0.6 mg/kg) with that of patients treated with high doses of prednisolone (≥0.6 mg/kg). 3 Including all cases, there was no significant survival advantage of high-dose prednisolone treatment. However, we surmised that severe AE-IPF cases could not be rescued by any treatment, and focused on comparatively mild cases.…”

“…In multivariate Cox proportional hazards regression analysis, high-dose prednisolone had a significant effect in cases without the introduction of positive pressure ventilation at AE diagnosis. 3 In Farrand et al's study, 1 AE-IPF was diagnosed based on Collard et al's international working group report criteria of 2016, 4 and included very mild patients without partial pressure arterial oxygen (PaO 2 ) decline compared with stable state. In addition, acute lung injuries caused by procedures, infections, drug toxicity and/or aspiration were also included as triggered cases.…”

IPF-Acute Exacerbations: Advances and Future Perspectives

“…Similarly, a retrospective study from Korea failed to show improved outcomes in IPF-AEs from high-dose steroid administration ( Jang et al, 2021 ). To consolidate the knowledge on the role of steroids in the management of IPF-AEs certainly demands larger cohorts and controlled prospective studies, but the common practice of opting for their administration in high-dose pulses intending to halt the rapidly evolving clinical situation of the IPF patient under AE begins to appear less appealing, and an international debate “pro e con” steroids arises ( Papiris et al, 2017 ; Arai and Inoue, 2018 ; Sellarés and Bermudo, 2018 ; Arai and Inoue, 2020 ).…”