Chest
Clinical InvestigationsInflammatory Lung DiseaseCombined Corticosteroid and Cyclophosphamide Therapy Does Not Alter Survival in Idiopathic Pulmonary Fibrosis
Section snippets
Study Population
Patients seen at two institutions (National Jewish Medical and Research Center, Denver, CO and the Mayo Clinic, Rochester, MN) between 1984 and 2002 who received a diagnosis of IPF were retrospectively reviewed. Treated patients (n = 543) and untreated patients (n = 155) were matched by age at diagnosis (within 5 years) and baseline FVC% (within 5%). This identified 164 patients (82 treated/untreated matched patient pairs) who comprised the study group. The diagnosis of IPF was made by surgical
Patient Characteristics
Treated and untreated patients were well matched for age at diagnosis, gender, baseline FVC%, and smoking history (Table 1). The overall mean age at diagnosis was 67.6 years. There were 127 men and 37 women, equally distributed between the two groups. Overall, baseline FVC% was 67.2. A history of current or former smoking was present in approximately 70% of patients. Surgical lung biopsy was obtained in all treated patients and in 12 of the untreated patients (15%).
Survival: Treated vs Untreated
There was no difference in
DISCUSSION
Combined treatment with corticosteroid and cyclophosphamide therapy does not appear to alter survival in patients with IPF. The lack of survival benefit persists when only surgical biopsy-proven cases or cases with a FVC% ≥ 60 are analyzed. These findings support the concept that chronic persistent inflammation plays little role in the progression of IPF.19, 20, 21
Interpretation of previous studies addressing the impact of corticosteroid and cytotoxic therapy on survival is difficult and
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2017, Revue des Maladies RespiratoiresCitation Excerpt :La corticothérapie est associée à une morbidité importante à long terme [119]. Les biais méthodologiques [120–122] ou les résultats contradictoires [123,124] des études ayant évalué l’effet de la corticothérapie associée à un traitement immunomodulateur (par exemple, azathioprine ou cyclophosphamide) sur la survie des patients ne permettent pas de recommander cette association dans le traitement de la FPI. Une corticothérapie orale ne dépassant pas 10 mg/j de prednisone est parfois proposée pour son effet sur la toux lorsqu’elle est invalidante (cf. ci-dessous) [125].
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Supported by National Institutes of Health grants SCOR HL6767 and NHLBI HL07085.