Intravenous monthly pulse methylprednisolone treatment for ABPA in patients with cystic fibrosis

Abstract

High-dose IV-pulse methylprednisolone is an effective treatment for ABPA in CF with minor side effects.

Pulse methylprednisolone in allergic bronchopulmonary aspergillosis exacerbations

“…All the reports were in patients with ABPA complicating cystic fibrosis, and involved both adult and paediatric patients (table 1). Three reports used pulse methylprednisolone 10-20 mg?kg -1 as a steroid sparing agent for three consecutive days every month [9,10,12]. One report involves the use of high-dose methylprednisolone in a life-threatening ABPA exacerbation unresponsive to oral steroid, which is similar to our cases [11].…”

“…Both the index cases failed to respond to high doses of oral steroids and itraconazole and were managed with intravenous methylprednisolone pulse therapy. A systematic review of the PubMed and EMBASE databases using the search terms: ''allergic bronchopulmonary aspergillosis'' OR ''abpa'' OR ''abpm'' OR ''allergic bronchopulmonary mycosis'' yielded four reports (39 cases) on the use of high doses of intravenous methylprednisolone in the management of ABPA [9][10][11][12]. All the reports were in patients with ABPA complicating cystic fibrosis, and involved both adult and paediatric patients (table 1).…”

The basophil surface marker CD203c identifies Aspergillus species sensitization in patients with cystic fibrosis

“…Acute ABPA flares can be treated with intravenously administered pulsed methylprednisolone at 10-15 mg/kg/day for a three day period every month. 30,45 Methylprednisolone was administered to four CF-ABPA patients in this study and a trend towards reduction in Af-stimulated CD203c values was observed after treatment. However, this trend was not significant (P = 0.1604) warranting future longitudinal study with increased numbers to examine the effect of corticosteroid treatment on Af sensitization and potentially the use of the BAT to monitor treatment responses.…”

“…16,31 For this reason, identifying individuals with Af sensitization with or without ABPA is important to ensure appropriate and timely therapeutic intervention to minimize pulmonary impact. 30 In this study we focused on the basophil activation marker CD203c as an indicator of Af sensitization and assessed its effect on important clinical measures of CF disease.…”

“…Additionally, in a small number of patients (n = 4) receiving monthly pulses of high dose intravenous methylprednisolone for ABPA (10-15 mg/kg for three days), 30 a trend towards efficacy of treatment was observed with Af-stimulated CD203c values halving (57.6%) one week after treatment initiation (P = 0.1604, Supporting Figure E6). This trend however decreased to 30% after one month, and prior to the next infusion of corticosteroids (n = 4, P = 0.2672; Supporting Figure E6), suggestive of the transient effect of corticosteroid therapy with time.…”