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Factors Predictive for Immunomodulatory Therapy Response and Survival in Patients with Hypersensitivity Pneumonitis—Retrospective Cohort Analysis
Hypersensitivity pneumonitis (HP) is one of the interstitial lung diseases with clearly established diagnostic criteria. Nevertheless, pharmacologic treatment recommendations are still lacking. Most specialists use steroids as first-line drugs, sometimes combined with an immunosuppressive agent. Aim...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9689222/ https://www.ncbi.nlm.nih.gov/pubmed/36428827 http://dx.doi.org/10.3390/diagnostics12112767 |
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author | Lewandowska, Katarzyna B. Barańska, Inga Sobiecka, Małgorzata Radwan-Rohrenschef, Piotr Dybowska, Małgorzata Franczuk, Monika Roży, Adriana Skoczylas, Agnieszka Bestry, Iwona Kuś, Jan Tomkowski, Witold Z. Szturmowicz, Monika |
author_facet | Lewandowska, Katarzyna B. Barańska, Inga Sobiecka, Małgorzata Radwan-Rohrenschef, Piotr Dybowska, Małgorzata Franczuk, Monika Roży, Adriana Skoczylas, Agnieszka Bestry, Iwona Kuś, Jan Tomkowski, Witold Z. Szturmowicz, Monika |
author_sort | Lewandowska, Katarzyna B. |
collection | PubMed |
description | Hypersensitivity pneumonitis (HP) is one of the interstitial lung diseases with clearly established diagnostic criteria. Nevertheless, pharmacologic treatment recommendations are still lacking. Most specialists use steroids as first-line drugs, sometimes combined with an immunosuppressive agent. Aim: The aim of the present retrospective study was to establish predictive factors for treatment success and survival advantage in HP patients. Methods: We analyzed the short-term treatment outcome and overall survival in consecutive HP patients treated with prednisone alone or combined with azathioprine. Results: The study group consisted of 93 HP patients, 54 (58%) with fibrotic HP and 39 (42%) with non-fibrotic HP. Mean (± SD) VCmax % pred. and TL,co % pred. before treatment initiation were 81.5 (±20.8)% and 48.3 (±15.7)%, respectively. Mean relative VCmax and TL,co change after 3–6 months of therapy were 9.5 (±18.8)% and 21.4 (±35.2)%, respectively. The short-term treatment outcomes were improvement in 49 (53%) patients, stabilization in 16 (17%) patients, and progression in 28 (30%) patients. Among those with fibrotic HP, improvement was noted in 19 (35%) cases. Significant positive treatment outcome predictors were fever after antigen exposure, lymphocyte count in broncho-alveolar lavage fluid (BALF) exceeding 54%, RV/TLC > 120% pred., and ill-defined centrilobular nodules in high-resolution computed tomography (HRCT). An increased eosinophil count in BALF and fibrosis in HRCT were significant negative treatment outcome predictors. The presence of fibrosis in HRCT remained significant in a multivariate analysis. A positive response to treatment, as well as preserved baseline VCmax (% pred.) and TLC (% pred.), predicted longer survival, while fibrosis in HRCT was related to a worse prognosis. Conclusion: Immunomodulatory treatment may be effective in a significant proportion of patients with HP, including those with fibrotic changes in HRCT. Therefore, future trials are urgently needed to establish the role of immunosuppressive treatment in fibrotic HP. |
format | Online Article Text |
id | pubmed-9689222 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-96892222022-11-25 Factors Predictive for Immunomodulatory Therapy Response and Survival in Patients with Hypersensitivity Pneumonitis—Retrospective Cohort Analysis Lewandowska, Katarzyna B. Barańska, Inga Sobiecka, Małgorzata Radwan-Rohrenschef, Piotr Dybowska, Małgorzata Franczuk, Monika Roży, Adriana Skoczylas, Agnieszka Bestry, Iwona Kuś, Jan Tomkowski, Witold Z. Szturmowicz, Monika Diagnostics (Basel) Article Hypersensitivity pneumonitis (HP) is one of the interstitial lung diseases with clearly established diagnostic criteria. Nevertheless, pharmacologic treatment recommendations are still lacking. Most specialists use steroids as first-line drugs, sometimes combined with an immunosuppressive agent. Aim: The aim of the present retrospective study was to establish predictive factors for treatment success and survival advantage in HP patients. Methods: We analyzed the short-term treatment outcome and overall survival in consecutive HP patients treated with prednisone alone or combined with azathioprine. Results: The study group consisted of 93 HP patients, 54 (58%) with fibrotic HP and 39 (42%) with non-fibrotic HP. Mean (± SD) VCmax % pred. and TL,co % pred. before treatment initiation were 81.5 (±20.8)% and 48.3 (±15.7)%, respectively. Mean relative VCmax and TL,co change after 3–6 months of therapy were 9.5 (±18.8)% and 21.4 (±35.2)%, respectively. The short-term treatment outcomes were improvement in 49 (53%) patients, stabilization in 16 (17%) patients, and progression in 28 (30%) patients. Among those with fibrotic HP, improvement was noted in 19 (35%) cases. Significant positive treatment outcome predictors were fever after antigen exposure, lymphocyte count in broncho-alveolar lavage fluid (BALF) exceeding 54%, RV/TLC > 120% pred., and ill-defined centrilobular nodules in high-resolution computed tomography (HRCT). An increased eosinophil count in BALF and fibrosis in HRCT were significant negative treatment outcome predictors. The presence of fibrosis in HRCT remained significant in a multivariate analysis. A positive response to treatment, as well as preserved baseline VCmax (% pred.) and TLC (% pred.), predicted longer survival, while fibrosis in HRCT was related to a worse prognosis. Conclusion: Immunomodulatory treatment may be effective in a significant proportion of patients with HP, including those with fibrotic changes in HRCT. Therefore, future trials are urgently needed to establish the role of immunosuppressive treatment in fibrotic HP. MDPI 2022-11-12 /pmc/articles/PMC9689222/ /pubmed/36428827 http://dx.doi.org/10.3390/diagnostics12112767 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Lewandowska, Katarzyna B. Barańska, Inga Sobiecka, Małgorzata Radwan-Rohrenschef, Piotr Dybowska, Małgorzata Franczuk, Monika Roży, Adriana Skoczylas, Agnieszka Bestry, Iwona Kuś, Jan Tomkowski, Witold Z. Szturmowicz, Monika Factors Predictive for Immunomodulatory Therapy Response and Survival in Patients with Hypersensitivity Pneumonitis—Retrospective Cohort Analysis |
title | Factors Predictive for Immunomodulatory Therapy Response and Survival in Patients with Hypersensitivity Pneumonitis—Retrospective Cohort Analysis |
title_full | Factors Predictive for Immunomodulatory Therapy Response and Survival in Patients with Hypersensitivity Pneumonitis—Retrospective Cohort Analysis |
title_fullStr | Factors Predictive for Immunomodulatory Therapy Response and Survival in Patients with Hypersensitivity Pneumonitis—Retrospective Cohort Analysis |
title_full_unstemmed | Factors Predictive for Immunomodulatory Therapy Response and Survival in Patients with Hypersensitivity Pneumonitis—Retrospective Cohort Analysis |
title_short | Factors Predictive for Immunomodulatory Therapy Response and Survival in Patients with Hypersensitivity Pneumonitis—Retrospective Cohort Analysis |
title_sort | factors predictive for immunomodulatory therapy response and survival in patients with hypersensitivity pneumonitis—retrospective cohort analysis |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9689222/ https://www.ncbi.nlm.nih.gov/pubmed/36428827 http://dx.doi.org/10.3390/diagnostics12112767 |
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