WEDNESDAY, April 19, 2006 (HealthDay News) -- A U.S. government-funded study has dashed hopes that steroid treatment might improve survival of people in the last stages of the often-fatal lung condition called acute respiratory distress syndrome (ARDS).
A trial with 180 people who had ARDS for at least seven days found almost identical death rates -- 28.6 percent for those who did not get steroids, 29.2 percent for those who did. And the death rate was significantly higher when steroids were given to people with ARDS for 14 days or longer.
"The ARDS Clinical Research Network will not recommend that it [steroid therapy] be used," said Andrea Harabin, the U.S. National Heart, Lung, and Blood Institute project officer in charge of the network.
ARDS is a lung condition that develops in patients who are critically ill with other diseases, such as pneumonia or widespread bacterial infections, or who have sustained major injuries. Fluid builds up in the lungs until breathing becomes impossible. There is no specific treatment for the condition, and an estimated 30 percent to 70 percent of ARDS patients die. The federal government estimates that there are 150,000 cases of ARDS in the United States each year.
The hope was that steroid treatment could help by easing inflammation in the lungs of ARDS patients, Harabin said. "It was important to know whether this drug [methylprednisolone] worked," she said. "The study clearly showed that the effect that might have been suggested by previous, much smaller studies, was not there. At the dose and timing that this study used, steroid treatment would not be recommended."
Harabin added that the implication of the study's results are limited because "we only studied one dose and at one period of ARDS." But no further studies of steroid therapy are planned by the network, which will be looking at alternate treatments, she said.
There still might be a reason to try steroid treatment for some ARDS patients, perhaps when nothing else has helped and death is near, said Dr. Paul N. Lanken, professor of medicine and principal investigator for the ARDS network at the University of Pennsylvania.
"My personal belief would be to avoid them," Lanken said. "But if there was a very severe case in a young person who did not have ARDS for two weeks, I would look at the situation to think if there was anything else we could do. Physicians are not comfortable accepting a lethal condition."
The trial was reasonable research to attempt, he said, adding, "We had an open mind -- we weren't sure. We knew there were tradeoffs, but given at the right time, the right dose at the right state of the disease, would the side effects of the drug outweigh the potential benefits?"
The "no" answer that emerged from the study was not definitive, Lanken said. "We got more information for this equation that doctors are using every day to make decisions for their patients," he said, and the study results "are a yellow flag that if a physician does use them [steroids] they should be used cautiously and in selected patients, avoiding the group that had ARDS two weeks or longer."
More information
For more on ARDS and related conditions, visit the ARDS Support Center.
