Early corticosteroid dose tapering is associated with better prognosis in patients with acute exacerbations of idiopathic pulmonary fibrosis (IPF), according to a study published in Respiratory Research.
IPF is one of the most common idiopathic interstitial pneumonias. It is characterized by progressive lung fibrosis and carries a poor prognosis. In addition, patients tend to experience recurrent acute exacerbations of their condition, requiring frequent hospital visits and raking up significant healthcare expenditures.
Corticosteroid therapy has remained the staple therapeutic strategy to deal with acute exacerbations of IPF. The corticosteroid dose is usually tapered, even though there is no consensus on the best way for this to be carried out. This is because there are no large-scale studies that look into the effects of corticosteroid dose tapering in patients with acute exacerbations of IPF.
The authors of the study thus set out to characterize the relationship between early tapering of prescribed corticosteroids and short-term prognosis in patients suffering from acute exacerbations of IPF. They hypothesized that early tapering can result in a better prognosis.
Read more about IPF epidemiology
The retrospective study was conducted using data from 8 Japanese tertiary care hospitals and a Japanese administrative cohort. The research team recruited patients over the age of 40 with conditions related to acute exacerbations of IPF but not secondary to interstitial pneumonia. A robust exclusion criteria was implemented, excluding patients with comorbid advanced cancer, unilateral pneumonia, refusal of treatment, among others. Ultimately, eligibility was determined by 2 pulmonologists based on recommendations from various international respiratory societies.
Patients were segregated according to the timing of corticosteroid dose tapering imposed upon them. The primary outcome was all-cause in-hospital mortality within 90 days.
“We found that early corticosteroid dose tapering was associated with a favorable prognosis in both cohorts,” the authors concluded. “The results of our study suggest that it may be beneficial to taper the corticosteroid dose early in patients with acute exacerbations of IPF.”
In light of these findings, physicians should consider tapering corticosteroid doses early in patients with acute exacerbations of IPF when clinically permissible to do so.
Anan K, Kataoka Y, Ichikado K, et al. Early corticosteroid dose tapering in patients with acute exacerbation of idiopathic pulmonary fibrosis. Respir Res. 2022;23(1):291 doi:10.1186/s12931-022-02195-3