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Effect of high-dose intravenous methylprednisolone pulse (IVMP) therapy in the survival of patients with anti-melanoma differentiation-associated gene 5-related rapidly progressive interstitial lung disease: a retrospective analysis

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Abstract

Objectives

To assess the impacts of high-dose intravenous methylprednisolone pulse (IVMP) therapy in survival and the occurrences of treatment-related infection of patients with anti-melanoma differentiation-associated gene 5 antibody-related rapidly progressive interstitial lung disease (MDA5-RPILD).

Methods

Patients with MDA5-RPILD from June 2017 to August 2022 in our hospital were retrospectively reviewed. IVMP therapy was defined as intravenous methylprednisolone (mPSL) 0.5g/day for 3 consecutive days during hospitalization or 7 days prior to admission and patients were divided into IVMP group and non-IVMP group based on who had ever received IVMP therapy. All-cause mortality and the incidence of adverse events during treatment were compared between the two groups.

Results

Sixty-four patients with MDA5-RPILD were enrolled. Among them, twenty-three (35.9%) patients had ever received IVMP therapy. The overall mortality was comparable between IVMP and non-IVMP group (IVMP group: 22/23, 95.7% vs. non-IVMP group: 38/41, 92.7%, p=0.11). And the incidence of treatment-related infections was also close (IVMP group: 21/23, 91.3% vs. non-IVMP group: 32/41, 78.0%, p=0.30). After adjustment for gender, age, smoking history, duration from symptom onset to diagnosis, and combination with steroid-sparing agent treatment, the Cox proportional hazards model showed that IVMP therapy was not associated with an improved survival (adjusted HR 1.10; 95% CI 0.57–2.13; p=0.77).

Conclusion

Our study showed that the survival benefits and adverse events were comparable between IVMP-treated and untreated MDA5-RPILD patients. Future prospective trials are needed to investigate the optimal treatment regimen in MDA5-RPILD.

Key Points

• This observational study found that IVMP therapy may be not associated with an improved outcome in patients with MDA5-RPILD.

• Treatment-related infections are common; however, the incidence of treatment-related infections had no difference between IVMP and non-IVMP group.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank all the participants in the study. Thanks to all authors for their contributions to this article. We thank the associate editor and the reviewers for their useful feedback that improved this paper.

Funding

This work was funded by the National Natural Science Foundation of China (grant numbers 81570058, 82170076).

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Authors and Affiliations

  1. Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Jiangsu University,, Nanjing, 210008, Jiangsu, China

    Li Fan, Yan Li & Jinghong Dai

  2. Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China

    Wenting Lyu, Qingqing Xu, Yujuan Gao, Xiaohua Qiu, Hourong Cai & Jinghong Dai

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  1. Li Fan
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Fan, L., Li, Y., Lyu, W. et al. Effect of high-dose intravenous methylprednisolone pulse (IVMP) therapy in the survival of patients with anti-melanoma differentiation-associated gene 5-related rapidly progressive interstitial lung disease: a retrospective analysis. Clin Rheumatol 43, 1135–1143 (2024). https://doi.org/10.1007/s10067-024-06872-0

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