High‐dose prednisolone after intravenous methylprednisolone improves prognosis of acute exacerbation in idiopathic interstitial pneumonias

Abstract

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.

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

“…1 We agree that 'it is time to debate about corticosteroids in AE of idiopathic pulmonary fibrosis (IPF) (AE-IPF)'. We believe that our results may stimulate debate regarding the treatment of AE-IPF.…”

Acute Exacerbation of Idiopathic Pulmonary Fibrosis

“…Reduced forced vital capacity (FVC), non-smoker, and elevation of Krebs von den Lungen-6 (KL-6) have been reported as candidate risk factors for AE [15][16][17][18]. Recently, Arai et al [19] reported a diffuse HRCT pattern, lower serum IgG, and higher serum surfactant protein-D in AE diagnosis. Long-term oxygen therapy (LTOT) before AE and positive pressure ventilation (PPV) use for AE were significant poor prognostic factors [19].…”

“…Recently, Arai et al [19] reported a diffuse HRCT pattern, lower serum IgG, and higher serum surfactant protein-D in AE diagnosis. Long-term oxygen therapy (LTOT) before AE and positive pressure ventilation (PPV) use for AE were significant poor prognostic factors [19].…”

“…In the acute phase, high-dose prednisolone is maintained. Arai et al [19] reported that high-dose prednisolone of ≥0.6 mg/kg was a significant prognostic factor for no-PPV patients. After starting prednisolone, cellular immunity decreased.…”

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

“…Interestingly, the subgroup that received the highest doses of corticosteroids tends to show a lower survival rate after 90 days (36% vs 22%) (Supplementary Information). 1 Additionally, we do not have any data regarding the cumulative effect of the total dose of steroids received by the patient, to demonstrate that in fact it could have a greater effect on the 90-day survival rate than the initial dose, especially in relation to adverse events. In addition, it is worth noting that the high dose of corticosteroids only improves survival in the non-ventilated patients.…”