| Short-Term Efficacy of Steroid and Immunosuppressive Drugs in Patients with Idiopathic Pulmonary Fibrosis and Pre-treatment Factors Associated with Favorable Response. |
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Kyeong Woo Kang, Sang Joon Park, Young Min Koh, Sang Pyo Lee, Gee Young Suh, Man Pyo Chung, Jungho Han, Hojoong Kim, O Jung Kwon, Kyung Soo Lee, Chong H Rhee |
1Division of Pulmonology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
2Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
3Department of Diagnostic Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
4Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. |
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| Abstract |
BACKGROUND
Idiopathic pulmonary fibrosis (IPF) is a diffuse inflammatory and fibrosing process that occurs within the interstitium and alveolus of the lung with invariably poor prognosis. The major problem in management of IPF results from the variable rate of disease progression and the difficulties in predicting the response to therapy. The purpose of this retrospective study was to evaluate the shortterm efficacy of steroid and immunosuppressive therapy for IPF and to identify the pre-treatment determinants of favorable response. METHOD: Twenty patients of IPF were included. Diagnosis of IPF was proven by thoracoscopic lung biopsy and they were presumed to have active progressive disease. The baseline evaluation in these patients included clinical history, pulmonary function test, bronchoalveolar lavage (BAL), and chest high resolution computed tomography (HRCT). Fourteen patients received oral prednisolone treatment with initial dose of 1mg/kg/day for 8 to 12 weeks and then tapering to low-dose prednis olone (0.5mg/kg/day). Six patients who previously had experienced significant side effects to steroid received 2mg/kg/day of oral cyclophosphamide with or without low-dose prednisolone. Follow-up evaluation was performed after 6 months of therapy. If patients met more than one of followings, they were considered to be responders: (1)improvement of more than one grade in dyspnea index, (2)improvement in FVC or TLC more than 10% or improvement in DLco more than 20% (3) decreased extent of disease in chest HRCT findings. RESULT: One patient died of extrapulmonary cause after 3 month of therapy, and another patient gave up any further medical therapy due to side effect of steroid. Eventually medical records of 18 patients were analyzed. Nine of 18 patients were classified into responders and the other nine patients into nonresponders. The histopathologic diagnosis of the responders were all nonspecific interstitial pneumonia (NSIP) and that of nonresponders were all usual interstitial pneumonia (UIP) (p<0.001). The other significant differences between the two groups were female predominance (p<0.01), smoking history (p<0.001), severe grade of dyspnea (p<0.05), lymphocytosis in BAL fluid (23.8+/-16.3% vs 7.83+/-3.6%, p < 0.05), and less honeycombing in chest HRCT findings (0% vs 9.22+/-2.3%, p < 0.001). CONCLUSION: Our results suggest that patients with histopathologic diagnosis of NSIP or lymphocytosis in BAL fluid are more likely to respond to steroid or immunosuppressive therapy. Clinical results in large numbers of IPF patients will be required to identify the independent variables. |
| Key Words:
Idiopathic pulmonary fibrosis, Usual interstitial pneumonia, Nonspecific interstitial pneumonia, Steroid, Immunosuppressive therapy |
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