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Open Access 01-12-2015 | Research article

Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival

Authors: Noriyuki Enomoto, Masashi Mikamo, Yoshiyuki Oyama, Masato Kono, Dai Hashimoto, Tomoyuki Fujisawa, Naoki Inui, Yutaro Nakamura, Hideo Yasuda, Akihiko Kato, Soichiro Mimuro, Matsuyuki Doi, Shigehito Sato, Takafumi Suda

Published in: BMC Pulmonary Medicine | Issue 1/2015

Abstract

Background

Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) has an extremely poor prognosis and there is currently no effective treatment for this condition. Direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) improves oxygenation, but it is unclear whether treatment of AE-IPF with PMX-DHP affects survival. This study elucidated the effectiveness and safety of PMX-DHP for the treatment of AE-IPF.

Methods

This study included 31 patients with 41 episodes of AE-IPF. All patients received steroids. Of 31, 14 patients (20 episodes) were treated with PMX-DHP. The laboratory and physiological test results after the start of therapy and survival were retrospectively compared between patients treated with and without PMX-DHP.

Results

Patients treated with PMX-DHP had a significantly greater change in PaO₂/FiO₂ ratio (mean ± SEM, 58.2 ± 22.5 vs. 0.7 ± 13.3, p = 0.034) and a smaller change in white blood cell count (−630 ± 959 /μL vs. 4500 ± 1190 /μL, p = 0.002) after 2 days of treatment than patients treated without PMX-DHP. The 12-month survival rate was significantly higher in patients treated with PMX-DHP (48.2% vs. 5.9%, p = 0.041). PMX-DHP was effective in patients with more severe underlying disease (GAP stages II or III; 12-month survival rate 57.1% with PMX-DHP vs. 0% without PMX-DHP, p = 0.021). Treatment with PMX-DHP was an independent predictor of better prognosis (hazard ratio 0.345, p = 0.037). Mild pulmonary thromboembolism occurred in one patient treated with PMX-DHP.

Conclusions

Treatment of AE-IPF with PMX-DHP is tolerable and improves 12-month survival.

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Title: Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival
Authors: Noriyuki Enomoto
Masashi Mikamo
Yoshiyuki Oyama
Masato Kono
Dai Hashimoto
Tomoyuki Fujisawa
Naoki Inui
Yutaro Nakamura
Hideo Yasuda
Akihiko Kato
Soichiro Mimuro
Matsuyuki Doi
Shigehito Sato
Takafumi Suda
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Pulmonary Medicine / Issue 1/2015
Electronic ISSN: 1471-2466
DOI: https://doi.org/10.1186/s12890-015-0004-4

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Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival

Abstract

Background

Methods

Results

Conclusions

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