Combined corticosteroid and cyclophosphamide therapy does not alter survival in idiopathic pulmonary fibrosis
Combined corticosteroid and cyclophosphamide therapy does not alter survival in idiopathic pulmonary fibrosis
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DOI：
10.1378/chest.125.6.2169
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发表时间：
2004-06-01
期刊：
影响因子：
9.6
通讯作者：
Brown, KK
中科院分区：
文献类型：
--
作者：
Collard, HR;Ryu, JH;Brown, KK
研究目的：特发性肺纤维化（IPF）患者的常规治疗包括皮质类固醇和细胞毒性药物。到目前为止，还没有研究充分评估这种方法的好处。本研究回顾性比较了皮质类固醇和环磷酰胺联合治疗在符合当前IPF共识定义的大量患者中的应用。设计：回顾性确定患者，并在意向治疗的基础上进行治疗。接受治疗和未接受治疗的患者在初次就诊时的年龄和预测FVC百分比（FVC%）进行匹配。环境：两个学术三级转诊中心。患者或参与者：IPF的诊断基于当前的共识标准。共纳入164例患者（治疗组82例，未治疗组82例）。干预措施：治疗包括使用标准化方案的皮质类固醇和环磷酰胺联合治疗。测量和结果：组间年龄、FVC%、性别或吸烟状况无差异。治疗组（中位生存期为1431天）和未治疗组（中位生存期为1665天）之间无生存差异[p = 0.58]。当仅分析手术活检诊断（n = 24）或FVC%大于等于60 （n = 107）的患者时，治疗效果仍然缺乏。结论：我们的数据表明，皮质类固醇和环磷酰胺联合治疗对IPF患者的生存没有影响。这一发现支持了慢性炎症在IPF进展中起最小作用的不断发展的概念，并强调了在采用此类疗法之前仔细考虑其风险和益处的重要性。
Study objectives: Treatment of patients with idiopathic pulmonary fibrosis (IPF) conventionally includes corticosteroids and cytotoxic agents. No study to date has adequately evaluated the benefits of this approach. This study retrospectively compared combination corticosteroid and cyclophosphamide therapy in a large population of patients who meet the current consensus definition of IPF.Design: Patients were identified retrospectively and treatment addressed on an intention-to-treat basis. Treated and untreated patients were matched by age and percentage of predicted FVC (FVC%) at the time of the initial visit.Setting: Two academic tertiary referral centers.Patients or participants: The diagnosis of IPF was based on current consensus criteria. A total of 164 patients (82 treated and 82 untreated) were included.Interventions: Treatment consisted of combined corticosteroid and cyclophosphamide therapy using a standardized protocol.Measurements and results: There was no difference in age, FVC%, gender, or smoking status between groups. No survival difference was found between patients who were treated (median survival, 1,431 days) or untreated (median survival, 1,665 days) [p = 0.58]. The lack of treatment effect persisted when only those patients with a diagnosis by surgical biopsy (n = 24) or FVC% greater than or equal to 60 (n = 107) were analyzed.Conclusions: Our data suggest that combined corticosteroid and cyclophosphamide therapy has no impact on survival in patients with IPF. This finding supports the evolving concept that chronic inflammation plays a minimal role in the progression of IPF and reinforces the importance of careful consideration of the risks and benefits of such therapies prior to their institution.