From the Guidelines
Prednisone can be beneficial in managing chronic interstitial lung changes, particularly in inflammatory forms of interstitial lung disease (ILD), with a recommended dose not to exceed 60 mg daily and a slow taper over weeks-months 1.
Key Considerations
- The effectiveness of prednisone depends on the specific type of ILD and its underlying cause.
- For inflammatory ILDs, prednisone is often beneficial, but for fibrotic ILDs, corticosteroids generally provide limited benefit and may even be harmful long-term.
- Comprehensive evaluation, including high-resolution CT scans and possibly lung biopsy, is necessary to confirm the specific ILD type before starting prednisone.
- Patients should be monitored regularly for side effects, including blood glucose elevation, bone density loss, weight gain, mood changes, and increased infection risk.
- Gastric protection with a proton pump inhibitor and bone health supplementation (calcium and vitamin D) are typically recommended during treatment.
Treatment Approach
- A typical regimen starts with 0.5-1 mg/kg/day (usually 40-60 mg daily) for 4-12 weeks, followed by a slow taper over several months to minimize side effects while maintaining disease control.
- In patients who are not able to successfully taper off corticosteroids, or experience unfavorable adverse effects, or in patients where the length of corticosteroid therapy is predicted to be long-term, steroid-sparing agents should be initiated as maintenance therapy 1.
- Nintedanib, an antifibrotic, was recently approved for “progressive” fibrotic ILD phenotypes, which may also include those associated with Sjögren’s and other CTDs 1.
Monitoring and Follow-up
- Close follow-up is required for all pharmacological treatments.
- The frequency of subsequent testing is dictated by an individual patient’s pace of disease progression.
- Patients should undergo regular monitoring for side effects and disease progression, with adjustments to treatment as needed.
From the Research
Chronic Interstitial Changes of the Lung and Prednisone Course
- The effectiveness of prednisone in treating chronic interstitial changes of the lung is a topic of ongoing research, with some studies suggesting that it may be beneficial in certain cases 2.
- However, other studies have found that prednisone may not be effective in all types of interstitial lung disease, and that other treatments such as azathioprine or cyclophosphamide may be more effective in certain cases 3, 4, 5, 6.
- A study published in 1975 found that three patients with severe progressive interstitial lung disease who were refractory to steroid therapy showed long-term stabilization of lung function when treated with azathioprine or cyclophosphamide 3.
- Another study published in 2019 found that azathioprine treatment was associated with improved lung function and lower prednisone dose in patients with myositis-related interstitial lung disease 4.
- A study published in 2016 found that azathioprine was associated with a similar incidence of adverse outcomes as mycophenolate mofetil in patients with fibrotic connective tissue disease-associated interstitial lung disease 5.
- A study published in 2008 found that a therapeutic strategy combining intravenous cyclophosphamide followed by oral azathioprine was effective in treating worsening interstitial lung disease associated with systemic sclerosis 6.
Treatment Options
- Azathioprine may be a viable treatment option for certain types of interstitial lung disease, particularly those that are refractory to steroid therapy 3, 4, 5.
- Cyclophosphamide may also be effective in certain cases, particularly when used in combination with other treatments such as azathioprine 3, 6.
- Mycophenolate mofetil may be a suitable alternative to azathioprine in certain cases, particularly those where azathioprine is not tolerated 5.
- Prednisone may still be a useful treatment option in certain cases, particularly when used in combination with other treatments such as azathioprine or cyclophosphamide 2, 4, 6.