Cryptogenic organizing pneumonia medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
Medical Therapy
- The mainstay of the therapy is pharmacotherapy.
- Corticosteroids are used as first-line treatment for patients with the symptomatic and progressive disease.
- For asymptomatic mass lesions or nonprogressive disease, treatment is not required, observation is required till they become symptomatic.
Standardized regimens of corticosteroids for the symptomatic and progressive disease are:
- Preferred regimen (1) Prednisone 0.75 mg/kg PO q24h for 4 weeks.
- Followed by (2) Prednisolone 0.5 mg/kg PO q24h for 4 weeks.
- Followed by (3) Prednisolone 20mg PO q24h for 4 weeks.
- Followed by (4) Prednisolone 10mg PO q24h for 6 weeks.
- Followed by (5) Prednisolone 5mg PO q24h for 6 weeks before they were stopped.
Severe cases:
- Preferred regimen (1)Prednisolone 2mg/kg IV q24h for first 3-5 days.
Followed by the same regimen discussed above. Relapses:
- Relapses are very common with corticosteroids therapy.
- The predictors of relapses are:
- Delayed treatment.
- Increased gamma-glutamyltransferase levels.
- Increased alkaline phosphatase levels.
- Relapses occur while receiving prednisone at 20 mg daily; treat with increasing the dose and decreased as discussed above.