What is the treatment for Organizing Pneumonia?

From the Guidelines

Organizing pneumonia is typically treated with oral corticosteroids.

Treatment Overview

• The majority of patients recover completely with oral corticosteroids, but relapse is common 1.
• Corticosteroid therapy results in clinical recovery in two-thirds of the patients 1.
• The treatment of organizing pneumonia with corticosteroids is based on case series and observational studies, as there have been no placebo-controlled trials 1.

Corticosteroid Regimen

• A maximum initial dose of 0.5mg/kg prednisolone for 3 weeks has been used in some studies 1.
• The exact dosage and duration of corticosteroid therapy may vary depending on the individual patient and the severity of the disease.

Alternative Treatments

• Low-dose macrolide therapy has been used in some cases of organizing pneumonia, particularly in patients with diffuse panbronchiolitis (DPB) 1.
• However, the use of macrolides in organizing pneumonia is not as well established as corticosteroid therapy, and more research is needed to determine its effectiveness.

Clinical Considerations

• Patients with organizing pneumonia should be closely monitored for signs of relapse or progression to fibrosis, and treatment should be adjusted accordingly 1.
• The use of anti-fibrotic agents, such as nintedanib and pirfenidone, is being tested in clinical trials for the treatment of long-COVID lung fibrosis, but its effectiveness in organizing pneumonia is not yet established 1.

From the Research

Treatment Options for Organizing Pneumonia

The treatment for organizing pneumonia (OP) can vary depending on the underlying cause and severity of the disease. Some of the treatment options include:

• Corticosteroids: Corticosteroids are the standard treatment for OP, with a response rate of 70-80% in cases of cryptogenic organizing pneumonia 2. The initial dose is typically around 50 mg/d of prednisone, with a lengthy treatment duration 3.
• Clarithromycin: Clarithromycin has been shown to be an effective alternative treatment for OP, particularly in patients with good clinical status and a high probability of adverse events with corticotherapy 4, 5. A dose of 0.5 g twice daily for 3 months has been used in some studies.
• Immunoglobulins: In cases of corticosteroid-resistant and refractory OP, immunoglobulins such as intravenous immunoglobulins (IVIg) may be considered, especially in patients with immunoglobulin deficiency 6.
• Other treatments: Other treatment options, such as mycophenolate and glucocorticosteroids, may be used in cases of secondary OP or in patients who do not respond to initial treatment 6.

Factors Influencing Treatment Choice

The choice of treatment for OP may depend on various factors, including:

• Underlying cause: The underlying cause of OP, such as infection, collagen vascular disease, or cancer, may influence the choice of treatment.
• Disease severity: The severity of OP, including the presence of respiratory insufficiency, may affect the treatment approach.
• Pulmonary function: Pulmonary function parameters, such as forced vital capacity (FVC) and forced expiratory volume (FEV1), may help identify patients who can be successfully treated with clarithromycin 5.
• Patient characteristics: Patient characteristics, such as age, comorbidities, and potential for adverse events, may also influence the treatment choice.