Pulse vs nonpulse corticosteroid: Which works better against acute exacerbation of IPF?

Patients with acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) who received a pulse dose of corticosteroids do not appear to have longer survival than those who received conventional nonpulse dose of corticosteroids, results of a study have shown.

In total, 238 patients with AE-IPF treated with corticosteroids at a tertiary referral hospital between January 2013 and December 2021 were included in this retrospective analysis. They were divided into pulse and nonpulse regimen groups based on whether a pulse corticosteroid dose (methylprednisolone ≥250 mg/day or equivalent) was given within 7 days of hospitalization for AE-IPF or not.

Using multivariable regression and propensity score-matched analyses, the authors compared the survival outcomes between the two treatment groups.

Of the patients, 59 received a pulse dose of corticosteroids, while 179 received a conventional nonpulse regimen. After adjusting for confounders related to the baseline clinical and radiographic severity, the pulse regimen fell short of reducing mortality risk at 3 months (adjusted hazard ratio [aHR], 0.84, 95 percent confidence interval [CI], 0.45‒1.38) or 12 months (aHR, 0.96, 95 percent CI, 0.60‒1.25) as compared with the nonpulse dose. Similar results appeared in the propensity score-matched analysis.

“The survival outcomes of patients with AE-IPF who received a pulse dose of corticosteroids did not differ from those of patients who received conventional nonpulse dose of corticosteroids,” the authors said. “Further prospective studies are required to establish the optimal initial dose of corticosteroids for the treatment of AE-IPF.”