Corticosteroid use does not improve outcomes in acute exacerbation of IPF

Use of corticosteroid is not associated with improved outcomes in idiopathic pulmonary fibrosis (IPF) patients admitted to the hospital with acute exacerbation (AE), reveals a recent study. In addition, corticosteroids may even contribute to reduced overall survival following exacerbation.

“AE‐IPF has profound prognostic implications, preceding approximately half of all IPF‐related deaths,” the authors said. “Corticosteroids remain the mainstay of treatment despite a lack of strong supporting evidence and mounting concern that they may be harmful.”

Using a code-based algorithm followed by case validation, the authors retrospectively identified AE-IPF patients in the University of California, San Francisco medical centre’s electronic health records from 1 January 2010 to 1 August 2018. They used a Cox model to assess the association between corticosteroid use and in-hospital mortality and a propensity score to control for confounding by indication. Overall survival and hospital readmissions were the secondary outcomes.

Of the 82 AE-IPF patients identified, 37 (45 percent) received corticosteroids. Those who received corticosteroids had a higher likelihood of needing intensive care unit level care and mechanical ventilation. No statistically significant association was observed between corticosteroid treatment and in-hospital mortality (propensity score weighted, adjusted hazard ratio [HR], 1.31, 95 percent confidence interval [CI], 0.26–6.55; p=0.74).

Of note, AE-IPF patients treated with corticosteroids had a lower overall survival (HR, 6.17, 95 percent CI, 1.35–28.14; p=0.019).

“Observational cohort studies using larger real‐world cohorts can more definitively assess the relationship between corticosteroid treatment and short‐term outcomes in AE‐IPF,” the authors said.