In the Journals

Patients with idiopathic pulmonary fibrosis acute exacerbations, immunosuppression at increased risk

Patients with idiopathic pulmonary fibrosis acute exacerbations and a history of immunosuppression have a higher risk for death, according to recent research.

“We found that the history of immunosuppression before [idiopathic pulmonary fibrosis acute exacerbation (IPF-AE)] adversely influences survival,” Spyros A. Papiris, MD, PhD, FCCP, from the 2nd pulmonary medicine department at Attikon University Hospital in Athens, Greece, and colleagues wrote. “Avoiding steroids in [idiopathic pulmonary fibrosis (IPF)] patients may favor the natural history of the disease even at the moment of its most devastating event.”

Papiris and colleagues evaluated 85 patients admitted to the hospital between 2007 and 2013 who had IPF deterioration and were treated using best supportive care, according to the abstract. If patients were immunosuppressed, researchers stopped those treatments and provided a thorough medical evaluation, which included broad-spectrum antimicrobials and examining any reversible causes of deterioration. Researchers analyzed IPF-AE both as unique events and unique patients, with the latter comprising an analysis that excluded IPF-AE that developed after exacerbation in some patients.

Researchers categorized 28% (n = 24) as having IPF-AE, according to the abstract. When analyzing unique events, Papiris and colleagues found there was a 50% survival rate and among these patients, 25% (n = 3) had previously been immunosuppressed (P = .041). When analyzing unique patients, they found there was a 35.3% survival rate, which included 3 of 6 patients (50%) who were never treated and 3 of 11 patients (27.3%) who received immunosuppression (P = .685).

The researchers noted that patients in the group that was never treated had a higher likelihood for survival (P = .022) and that a history of immunosuppression was a significant event that adversely influenced survival (P = .035), according to the abstract. After discharge, Papiris and colleagues reported an 83% 1-year survival rate for patients with IPF-AE. – by Jeff Craven

Disclosure: The researchers report no relevant financial disclosures.