Pulse corticosteroid therapy in interstitial lung disease-associated with anti-aminoacyl-tRNA synthetase antibodies: Comparable efficacy with potential for reduced adverse events

Abstract

Background and objective

The optimal treatment modality for interstitial lung disease (ILD) associated with anti-aminoacyl-tRNA synthetase (ARS) antibodies remains controversial. This study aimed to compare the efficacy and safety of pulse corticosteroid therapy with that of conventional corticosteroid therapy in patients with anti-ARS ILD.

Methods

This retrospective cohort study included 62 patients with anti-ARS ILD. Patients were divided into two groups: Those who received pulse corticosteroid therapy (500–1000 mg of methylprednisolone intravenously for three days) and those who received conventional corticosteroid therapy. Primary outcomes included initial treatment response at one year and disease recurrence. Secondary outcomes were alterations in pulmonary function tests, KL-6 levels, prednisolone dose, and adverse events.

Results

Both the pulse corticosteroid therapy group and the conventional therapy group had similar rates of initial treatment improvement (90.3 % vs. 77.4 %, p = 0.301), with no significant differences in recurrence-free survival. Improvements in pulmonary function tests were comparable between the two groups. At 12 months, the mean daily prednisolone dose was 3.9 mg in the pulse therapy group compared with 6.0 mg in the conventional therapy group. The pulse corticosteroid therapy group also experienced fewer adverse events (25.8 % vs. 61.3 %, p = 0.010).

Conclusion

Pulse corticosteroid therapy provides similar treatment efficacy, earlier reduction in corticosteroid dosage, and a lower incidence of adverse events compared to conventional therapy in patients with anti-ARS ILD. These findings highlight the potential benefit of a steroid-sparing strategy, suggesting that pulse corticosteroid therapy may be considered an effective and safer option in managing this condition.