Use of Corticosteroids for Treatment of Interstitial Lung Disease

Abstract

The use of corticosteroids for treatment of interstitial lung disease (ILD) is problematic because of significant side effects and limited efficacy in some ILDs, particularly idiopathic pulmonary fibrosis (IPF). This review summarizes recent data and controversies regarding corticosteroid therapy in IPF and sarcoidosis. A few trials, which have compared corticosteroids alone with corticosteroids in combination with immunosuppressives for patients with IPF, suggest that combination therapy is more effective and should be the first-line empiric therapy. Other anti-inflammatory agents such as colchicine do not appear to be more effective than corticosteroids but are better tolerated. Therapy with new antifibrotic agents such as pirfenidone and interferon appears promising; however, its efficacy needs to be established in well-designed, long-term studies with control populations. Although corticosteroids are highly effective in treating acute symptoms and functional deterioration in sarcoidosis, the long-term benefit of chronic corticosteroid use for patients who fail to remit is probably small. Alternative therapies, particularly methotrexate, have been used to suppress clinical deterioration in sarcoidosis. Although results in some studies are encouraging, the efficacy of methotrexate and/or an alternative regimen in the treatment of sarcoidosis remains to be established. Clin Pulm Med 2000;7(1):9-14