Clinical studySteroids in idiopathic pulmonary fibrosis: a prospective assessment of adverse reactions, response to therapy, and survival∗☆,
Section snippets
Sample
We included all patients referred to the University of Michigan for enrollment in the specialized center of research protocol for idiopathic pulmonary fibrosis, as diagnosed by symptoms, physiologic abnormalities, and radiographic findings. No patient had undergone previous surgical lung biopsy or received therapy. We excluded patients with other medical problems, and those who were unable or unwilling to undergo surgical lung biopsy.
Physiologic assessments
We measured pulmonary flows and volume, and the diffusing
Results
There were similar numbers of men and women in the sample (Table 1). When we compared the initial 24 patients who were treated with somewhat higher doses of prednisone with the subsequent 17 patients, we found that the mean total pathology scores (26 ± 2 versus 20 ± 2, P = 0.02) and the interstitial disease score on the CT scan (1.8 ± 0.2 versus 1.3 ± 0.2, P = 0.05) were somewhat greater in the patients who had been in the initial group.
Discussion
The corticosteroid dosage regimens that were used during the study period were chosen based on reports in the literature 6, 7, 20. Given the high incidence of side effects during the early phase of our study, we reduced the dose (from about 100 mg to 60 mg per day) in 17 patients. Nevertheless, we observed that steroid-related side effects occurred in all 41 patients with idiopathic pulmonary fibrosis. However, survival was better in patients who remained stable or responded to initial
Acknowledgements
We are grateful for the assistance and expertise provided by Phillip Cascade, MD, and David Spizarny, MD, while scoring CT scans associated with this investigation.
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Supported in part by the National Institutes of Health (HL46487, RR00042, AG08808, HL04212).
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