Prospects for treatment of paraquat-induced lung fibrosis with immunosuppressive drugs and the need for better prediction of outcome: a systematic review

Abstract

The authors of the RCT have performed valuable and difficult research, but their results are hypothesis-forming rather than conclusive; elsewhere, the use of historical controls is problematic. In the absence of a validated prognostic marker, a large RCT of immunosuppression using death as the primary outcome is required. This RCT should also prospectively test and validate the available prognostic methods, so that future patients can be selected for this and other therapies on admission.

CT imaging as a prognostic indicator for patients with pulmonary injury from acute paraquat poisoning

“…Other alternative treatments were reported by Noh [17], who described the successful treatment of PQ-poisoned patients with combined high-dose cyclophosphamide and steroid therapies. Similarly, Eddleston et al [18] reported the use of antineutrophil therapy to prevent lung fibrosis, with mixed outcomes.…”

A rare case of Paraquat poisoning developing pneumothorax.

“…8 The treatment modalities are likely to be useful only if the patient survives beyond 48 hours after poisoning. 9 Cyclophosphamide could not be administered in our patient because of renal failure. So, only methylprednisolone was administered.…”

Delayed immunosuppressive treatment in life-threatening paraquat ingestion: A case report

“…Our case clearly emphasizes the importance of initial alveolitis before the development of pulmonary fibrosis and the therapeutic role of immunosuppressive treatments. Due to the absence of intention-to-treat-based analysis in the previously published randomized clinical trials, the definitive efficacy of these immunosuppressive treatments is still debated [15]. When PaO2 falls below 60 mmHg, repeated courses of immunosuppressive therapies consistently demonstrate reduced mortality rates in severe poisonings [3,4].…”