title: Tacrolimus and steroid treatment for acute exacerbation of idiopathic pulmonary fibrosis.
abstract: OBJECTIVE
  Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) occurs during the chronic progressive course of idiopathic pulmonary fibrosis. Mortality is estimated to be >70%, because no effective treatment has been established. We evaluated the effectiveness of combination therapy of tacrolimus and methylprednisolone for AE-IPF.
  
  
  METHODS
  Patients of AE-IPF treated with methylprednisolone pulse therapy with or without tacrolimus (targeting 20 ng/mL) during the period between January 2001 and April 2010 were retrospectively reviewed. The primary endpoints were survival rate and duration. We also observed lactate dehydrogenase levels, partial pressure of arterial oxygen/fraction of inspired oxygen ratio (P/F ratio), KL-6, occurrence of re-exacerbation, and computed tomography score.
  
  
  RESULTS
  Fifteen Japanese patients [tacrolimus group aged 74.2±6.0 years old (n=5), non-tacrolimus group aged 75.1±12.8 years old (n=10)] were identified. Pre-treatment clinical parameters were not significantly different between the two groups. Four of 5 tacrolimus group patients and 1 of 10 non-tacrolimus group patients survived (p<0.05). The median survival durations were >92 days (tacrolimus group) and 38 days (non-tacrolimus group) (p<0.05). Lactate dehydrogenase levels and the P/F ratio were also significantly favorable in the tacrolimus group. KL-6 and CT score were not significantly different in both groups. Four re-acute exacerbations were observed only in the non-tacrolimus group.
  
  
  CONCLUSIONS
  Combined tacrolimus and methylprednisolone pulse therapy mitigates AE-IPF, prevents re-acute exacerbation, and contributes to a better prognosis.
authors.affiliation: Department of Allergy and Respiratory Medicine, The Fraternity Memorial Hospital, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Horita
authors.forename: Makiko
authors.initials: M
authors.lastname: Akahane
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Okada
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Takahiko
authors.initials: T
authors.lastname: Arai
authors.forename: Izuki
authors.initials: I
authors.lastname: Amano
authors.forename: Tomoko
authors.initials: T
authors.lastname: Takezawa
authors.forename: Masako
authors.initials: M
authors.lastname: To
authors.forename: Yasuo
authors.initials: Y
authors.lastname: To
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000188:drug therapy* / Q000401:mortality; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D011379:Prognosis; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D007770:L-Lactate Dehydrogenase; D010100:Oxygen; D016559:Tacrolimus; D008775:Methylprednisolone