Systemic corticosteroids in fibrotic lung disease: a systematic review and meta-analysis

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.

Keywords: Clinical Epidemiology; Interstitial Fibrosis; Systemic disease and lungs.

Figure 1

PRISMA flow diagram presenting the inclusion and exclusion process. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2

All-cause mortality forest plot. REML, restricted maximum likelihood.

Figure 3

Change in FVC (% predicted) by fILD subgroups. fILD, fibrotic interstitial lung disease; FVC, forced vital capacity; IPF, idiopathic pulmonary fibrosis; REML, restricted maximum likelihood.