How effective is longer-term corticosteroid treatment vs short-burst therapy?

Updated: Sep 15, 2020
  • Author: Nader Kamangar, MD, FACP, FCCP, FCCM; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

The best study addressing corticosteroids was the multicenter trial from Britain sponsored by the British Thoracic Society. In this nonrandomized study, 55 patients were selectively observed or treated with corticosteroids. Additionally, patients who were thought to have an immediate indication for steroids were treated. The trial required a 6-month run-in period to exclude patients who improved spontaneously. At the end of the trial, the groups treated with long-term steroids fared better on some measures than did the patients who were observed and treated with short bursts of steroids (see Table 1 below for detail).

Table 2. Results of Multicenter Trial Sponsored by the British Thoracic Society (Open Table in a new window)

Characteristics

Group La

Group Sb

P

Dyspnea score (range 1-4)

0.24

0.47

NS

Fibrosis score (range 0-16)

0.83

1.47

NS

FEV1c (% predicted)

95.9

86.9

0.05

VCd (% predicted)

99.8

90.8

0.02

DLCOe (% predicted)

84.3

77.7

NS

Weight gain (kg)

+3.26

+0.99

0.02

a Long-term steroids.

b Short bursts of steroids.

c Forced expiratory volume in 1 second.

d Ventilatory capacity.

e Diffusing capacity of lung for carbon monoxide.

Acthar gel (repository corticotropin injection) was used to treat pulmonary sarcoidosis in the 1950s. It was abandoned because of cost and toxicity compared with prednisone. More recently, it has been suggested as an alternative in patients who are on high-dose prednisone. [60, 61]  


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