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Interstitial lung disease
Systemic corticosteroids in fibrotic lung disease: a systematic review and meta-analysis
  1. Tyler Pitre1,
  2. Leticia Kawano-Dourado2,
  3. George V Kachkovski3,
  4. Darren Leung4,
  5. Gareth Leung5,
  6. Kairavi Desai3,
  7. Chunjuan Zhai6,
  8. Wendy Adams7,
  9. Manuela Funke-Chambour8,
  10. Michael Kreuter8,
  11. Iain Stewart9,
  12. Christopher J Ryerson10,
  13. Gisli Jenkins11 and
  14. Dena Zeraatkar12,13
  15. On behalf of the REMAP-ILD consortium
  1. 1Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Pulmonology, Heart Institute (InCor) - University of São Paulo Medical School, São Paulo, Brazil
  3. 3Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
  4. 4Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
  5. 5Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  6. 6Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
  7. 7Action for Pulmonary Fibrosis, London, UK
  8. 8Mainz Center for Pulmonary Medicine, Departments of Pneumology, Mainz University Medical Center and of Pulmonary, Critical Care & Sleep Medicine, Marienhaus, Mainz, Germany
  9. 9National Heart & Lung Institute, Imperial College London, London, UK
  10. 10Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
  11. 11Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, London, UK
  12. 12Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  13. 13Department of Anesthesiology, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Tyler Pitre; tyler.pitre{at}medportal.ca

Abstract

Objectives We aimed to assess the available evidence for corticosteroids in fibrotic interstitial lung disease (fILD) to inform the randomised embedded multifactorial adaptive platform ILD.

Design Systematic review and meta-analysis.

Data sources We searched Embase, Medline, Cochrane CENTRAL and Web of Science databases from inception to April 17 2023.

Eligibility criteria We included studies that compared corticosteroids with standard care, placebo or no treatment in adult patients with fILD.

Data extraction and synthesis We report on the change in forced vital capacity (FVC) and mortality. We used random-effects meta-analysis to estimate relative risk (RR) for dichotomous outcomes, and mean difference (MD) and standardised MDs for continuous outcomes, with 95% CIs.

Results Of the 13 229 unique citations identified, we included 10 observational studies comprising 1639 patients. Corticosteroids had an uncertain effect on mortality compared with no treatment (RR 1.03 (95% CI 0.85 to 1.25); very low certainty evidence). The effect of corticosteroids on the rate of decline in FVC (% predicted) was uncertain when compared with no treatment (MD 4.29% (95% CI −8.26% to 16.83%); very low certainty evidence). However, corticosteroids might reduce the rate of decline in FVC in patients with non-idiopathic pulmonary fibrosis (IPF) fILD (MD 10.89% (95% CI 5.25% to 16.53%); low certainty evidence), while an uncertain effect was observed in patients with IPF (MD −3.80% (95% CI −8.94% to 1.34%); very low certainty evidence).

Conclusions The current evidence on the efficacy and safety of corticosteroids in fILD is limited and of low certainty. Randomised trials are needed to address this significant research gap.

  • Interstitial Fibrosis
  • Systemic disease and lungs
  • Clinical Epidemiology

Data availability statement

Data are available on reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjresp-2023-002008

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Twitter @IPFdoc

    • Collaborators On behalf of the REMAP-ILD consortium collaborators listed in online supplemental file 1.

    • Contributors TP, LK-D, GJ and DZ came up with the study design, methods and data collection methods. TP, GVK, DL, GL and CZ screened titles and abstracts, full text and collected data. TP analysed and performed risk of bias and GRADE assessments in duplicate with DZ. TP wrote the first draft. WA, MF-C, MK, IS, CJR, LK-D and GJ provided content expertise, critical appraisal of the manuscript and helped write the final draft. DZ supervised the study. TP is the data guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.