Cryptogenic organizing pneumonia. Characteristics of relapses in a series of 48 patients. The Groupe d'Etudes et de Recherche sur les Maladles "Orphelines" Pulmonaires (GERM"O"P)

Cryptogenic organizing pneumonia (COP) is a clinicopathologic syndrome characterized by rapid resolution with corticosteroids, but frequent relapses when treatment is tapered or stopped. We retrospectively studied relapses in 48 cases of biopsy-proven COP. One or more relapses (mean 2.4 +/- 2.2) occ...

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Published inAmerican journal of respiratory and critical care medicine Vol. 162; no. 2 Pt 1; p. 571
Main Authors Lazor, R, Vandevenne, A, Pelletier, A, Leclerc, P, Court-Fortune, I, Cordier, J F
Format Journal Article
LanguageEnglish
Published United States 01.08.2000
Subjects
Adult
Aged
Alkaline Phosphatase - blood
Cholestasis - complications
Cryptogenic Organizing Pneumonia - drug therapy
Cryptogenic Organizing Pneumonia - mortality
Cryptogenic Organizing Pneumonia - physiopathology
Female
gamma-Glutamyltransferase - blood
Humans
Male
Middle Aged
Prednisone - adverse effects
Prednisone - therapeutic use
Probability
Recurrence
Retrospective Studies
Treatment Outcome
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Summary:Cryptogenic organizing pneumonia (COP) is a clinicopathologic syndrome characterized by rapid resolution with corticosteroids, but frequent relapses when treatment is tapered or stopped. We retrospectively studied relapses in 48 cases of biopsy-proven COP. One or more relapses (mean 2.4 +/- 2.2) occurred in 58%. At first relapse, 68% of patients were still under treatment for the initial episode. Compared with the no-relapse group, nine patients with multiple (>/= 3) relapses had longer delays between first symptoms and treatment onset (22 +/- 17 versus 11 +/- 8 wk, p = 0.02), and elevated gamma-glutamyltransferase (124 +/- 98 versus 29 +/- 13 IU/L, p = 0.001) and alkaline phosphatase (190 +/- 124 versus 110 +/- 68 IU/L, p = 0.04) levels. Relapses did not adversely affect outcome. Corticosteroid treatment side effects occurred in 25% of patients. Standardized treatment in 14 patients allowed a reduction of prednisone cumulated doses (p < 0.05) without affecting outcome or relapse rate. We conclude that: (1) delayed treatment increases the risk of relapses; (2) mild cholestasis identifies a subgroup of patients with multiple relapses; (3) relapses do not affect outcome, and prolonged therapy to suppress relapses appears unnecessary; (4) a standardized treatment allows a reduction in steroid doses.
ISSN:1073-449X
1535-4970