Atsumi Kenichiro, Nishima Shunichi, Tanaka Toru, Kamio Koichiro, Taniuchi Namiko, Saito Yoshinobu, Shimizu Masamitsu, Okano Tetsuya, Seike Masahiro, Hirose Takashi
Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, Japan
Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, Japan.
BMJ Open Respir Res. 2025 May 16;12(1):e002697. doi: 10.1136/bmjresp-2024-002697.
Long-term maintenance steroid therapy (MST) is often necessary for repeated relapses of chronic eosinophilic pneumonia (CEP). Because relapse does not indicate a worse prognosis, determining the optimal steroid dose to avoid overtreatment presents a clinical challenge. Our primary objective was to evaluate the optimal MST dose to prevent repeated relapses, and the secondary objectives included identifying serum eosinophil count at relapse and background factors of relapse.
A multicentre retrospective study was conducted on patients with steroid-treated CEP. Background characteristics were compared between the non-relapse and relapse groups. The optimal MST dose was determined based on dose at relapse and the final relapse prevention dose. Additionally, serum eosinophil count at relapse was assessed.
A total of 79 patients were included, with 44 in the non-relapse group and 35 in the relapse group. The prednisolone doses required to achieve relapse-free rates of 50% (ED) were 7.2 mg (95% CI, 4.6 to 23.6). The median serum eosinophil count at relapse was 1125 /µL (IQR, 735-2108). No clinically significant background factors were identified between the non-relapse and relapse groups.
Our study demonstrated that a prednisolone dose of 7.2 mg achieved a 50% relapse-free rate in the relapse group. Based on these findings, we encourage clinicians to evaluate individual minimum effective steroid doses.
对于慢性嗜酸性粒细胞性肺炎（CEP）反复复发的患者，长期维持性类固醇治疗（MST）通常是必要的。由于复发并不意味着预后更差，因此确定最佳类固醇剂量以避免过度治疗是一项临床挑战。我们的主要目标是评估预防反复复发的最佳MST剂量，次要目标包括确定复发时的血清嗜酸性粒细胞计数以及复发的背景因素。
对接受类固醇治疗的CEP患者进行了一项多中心回顾性研究。比较了未复发组和复发组的背景特征。根据复发时的剂量和最终预防复发的剂量确定最佳MST剂量。此外，还评估了复发时的血清嗜酸性粒细胞计数。
共纳入79例患者，其中未复发组44例，复发组35例。达到50%无复发率（ED）所需的泼尼松龙剂量为7.2mg（95%CI，4.6至23.6）。复发时血清嗜酸性粒细胞计数的中位数为1125/µL（IQR，735-2108）。未复发组和复发组之间未发现具有临床意义的背景因素。
我们的研究表明，泼尼松龙剂量为7.2mg时，复发组的无复发率达到50%。基于这些发现，我们鼓励临床医生评估个体最低有效类固醇剂量。
