Tacrolimus and Steroid Treatment for Acute Exacerbation of Idiopathic Pulmonary Fibrosis

• Horita Nobuyuki

  Department of Allergy and Respiratory Medicine, The Fraternity Memorial Hospital, Japan

• Akahane Makiko

  Department of Allergy and Respiratory Medicine, The Fraternity Memorial Hospital, Japan

• Okada Yukinori

  Department of Allergy and Respiratory Medicine, The Fraternity Memorial Hospital, Japan

• Kobayashi Yosuke

  Department of Allergy and Respiratory Medicine, The Fraternity Memorial Hospital, Japan

• Arai Takahiko

  Department of Allergy and Respiratory Medicine, The Fraternity Memorial Hospital, Japan

• Amano Izuki

  Department of Allergy and Respiratory Medicine, The Fraternity Memorial Hospital, Japan

• Takezawa Tomoko

  Department of Allergy and Respiratory Medicine, The Fraternity Memorial Hospital, Japan

• To Masako

  Department of Allergy and Respiratory Medicine, The Fraternity Memorial Hospital, Japan

• To Yasuo

  Department of Allergy and Respiratory Medicine, The Fraternity Memorial Hospital, Japan

抄録

Objective Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) occurs during the chronic progressive course of idiopathic pulmonary fibrosis. Mortality is estimated to be >70%, because no effective treatment has been established. We evaluated the effectiveness of combination therapy of tacrolimus and methylprednisolone for AE-IPF.<br> Methods Patients of AE-IPF treated with methylprednisolone pulse therapy with or without tacrolimus (targeting 20 ng/mL) during the period between January 2001 and April 2010 were retrospectively reviewed. The primary endpoints were survival rate and duration. We also observed lactate dehydrogenase levels, partial pressure of arterial oxygen/fraction of inspired oxygen ratio (P/F ratio), KL-6, occurrence of re-exacerbation, and computed tomography score.<br> Results Fifteen Japanese patients [tacrolimus group aged 74.2±6.0 years old (n=5), non-tacrolimus group aged 75.1±12.8 years old (n=10)] were identified. Pre-treatment clinical parameters were not significantly different between the two groups. Four of 5 tacrolimus group patients and 1 of 10 non-tacrolimus group patients survived (p<0.05). The median survival durations were >92 days (tacrolimus group) and 38 days (non-tacrolimus group) (p<0.05). Lactate dehydrogenase levels and the P/F ratio were also significantly favorable in the tacrolimus group. KL-6 and CT score were not significantly different in both groups. Four re-acute exacerbations were observed only in the non-tacrolimus group.<br> Conclusion Combined tacrolimus and methylprednisolone pulse therapy mitigates AE-IPF, prevents re-acute exacerbation, and contributes to a better prognosis.<br>

収録刊行物

• Internal Medicine

  Internal Medicine 50 (3), 189-195, 2011

  一般社団法人 日本内科学会

キーワード

• acute exacerbation of idiopathic pulmonary fibrosis
• acute lung injury
• acute respiratory distress syndrome
• corticosteroid
• tacrolimus

詳細情報

• CRID: 1390282679849528960
• NII論文ID: 130000413092
• DOI: 10.2169/internalmedicine.50.4327
• ISSN: 13497235
• ISSN: 09182918
• Web Site: http://www.jstage.jst.go.jp/article/internalmedicine/50/3/50_3_189/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2011287853
• 本文言語コード: en
• データソース種別:
  • JaLC
  • Crossref
  • CiNii Articles
• 抄録ライセンスフラグ: 使用不可