Baughman Robert P, Sweiss Nadera, Keijsers Ruth, Birring Surinder S, Shipley Ralph, Saketkoo Lesley Ann, Lower Elyse E
Department of Medicine, University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH, 45267, USA.
Department of Medicine, University of Illinois Chicago, Chicago, IL, USA.
Lung. 2017 Jun;195(3):313-322. doi: 10.1007/s00408-017-9994-4. Epub 2017 Mar 28.
The dose of repository corticotropin (RCI) and need for a loading dose in sarcoidosis patients receiving chronic corticosteroids are unclear. We performed a single-blind prospective study, comparing two doses of RCI in sarcoidosis.
Chronic pulmonary sarcoidosis patients receiving prednisone therapy with deterioration by 5% in FVC in the previous year were studied. RCI was administered subcutaneously at a loading dose of 80 units RCI for 10 days. Patients were randomized at day 14 to receive either 40- or 80-unit RCI twice a week. The dose of prednisone was modified by the clinician who was blinded to the patient's dosage of RCI.
Sixteen patients completed the full 24 weeks of the study. At week 24, there was a decrease in the dose of prednisone, and improvements in DLCO, King's Sarcoidosis Questionnaire health status and fatigue score. There was no significant change in FVC % predicted. For the PET scan, there was a significant fall in the standard uptake value (SUV) of the lung lesions. Only 3/8 patients remained on 80 units RCI for full 24 weeks. There was no significant difference in the response to therapy for those treated with 40- versus 80-unit RCI.
Repository corticotropin treatment was prednisone-sparing and associated with significant improvement in DLCO, PET scan, and patient-reported outcome measures. A dose of 40-unit RCI twice a week was as effective as 80-unit RCI and was better tolerated.
长效促肾上腺皮质激素（RCI）的剂量以及接受慢性皮质类固醇治疗的结节病患者是否需要负荷剂量尚不清楚。我们进行了一项单盲前瞻性研究，比较了结节病患者使用两种剂量的RCI的情况。
研究对象为前一年接受泼尼松治疗且用力肺活量（FVC）下降5%的慢性肺部结节病患者。给予负荷剂量80单位RCI皮下注射，持续10天。患者在第14天被随机分组，分别接受每周两次40单位或80单位的RCI治疗。泼尼松的剂量由对患者RCI剂量不知情的临床医生进行调整。
16名患者完成了为期24周的完整研究。在第24周时，泼尼松剂量降低，一氧化碳弥散量（DLCO）、结节病患者健康状况问卷评分及疲劳评分均有所改善。预计FVC%无显著变化。对于正电子发射断层扫描（PET），肺部病变的标准摄取值（SUV）显著下降。仅3/8的患者在24周内持续使用80单位的RCI。40单位与80单位RCI治疗患者的治疗反应无显著差异。
长效促肾上腺皮质激素治疗可减少泼尼松用量，并与DLCO、PET扫描及患者报告的结局指标显著改善相关。每周两次40单位的RCI与80单位的RCI疗效相同，且耐受性更好。
