Greater Steroid Doses Linked to Shorter Hospitalization in AE-SARD-ILD

Higher corticosteroid doses during hospitalization were associated with shorter length of stay among transplant-free survivors with acute exacerbations of systemic autoimmune-related disease-associated interstitial lung disease (AE-SARD-ILD), according to findings presented at the 2026 American Thoracic Society (ATS) International Conference in Orlando, Florida.

In an interview with HCPLive, Jamey Moore, DO, from Temple University Hospital, said the findings reinforce corticosteroids as the “backbone” of treatment for AE-SARD-ILD and suggest clinicians should consider more aggressive upfront dosing in carefully selected patients without evidence of infection.

“Steroids...should remain the mainstay of treatment,” Moore said.

The retrospective cohort study evaluated adults hospitalized with AE-SARD-ILD at Temple University Hospital between 2016 and 2024. Investigators assessed the relationship between average daily corticosteroid dose and hospital length of stay, as well as transplant-free survival outcomes.

The analysis included 52 patients with a mean age of 59 years, 65% of whom were female. Underlying rheumatologic conditions included rheumatoid arthritis, scleroderma, dermatomyositis, Sjögren syndrome, mixed connective tissue disease, anti-synthetase syndrome, and systemic lupus erythematosus.

Among 32 transplant-free survivors, a greater average daily corticosteroid dose was significantly associated with shorter hospitalization time, with a Spearman correlation coefficient of -0.66 (P < .001). Median daily steroid doses were also significantly greater among transplant-free survivors compared with patients who died or underwent transplantation during admission.

Moore noted the study did not identify a precise steroid threshold associated with improved outcomes but instead found a broader relationship between greater corticosteroid exposure and reduced hospitalization time.

The findings arrive as pulmonologists continue balancing the potential benefits of aggressive immunosuppression against the risk of infection, particularly in older or immunocompromised patients with autoimmune ILD. Moore emphasized that the investigators attempted to minimize this confounding factor by excluding patients with documented infections and focusing on individuals with negative infectious workups early during admission.

Moore cautioned against viewing the study as immediately practice-changing because of its retrospective, single-center design and the possibility that transplant-free survivors represented a healthier subgroup. However, the results may influence clinician decision-making.

“I think it should put a thought into your mind that if you’re admitting this patient, and it doesn’t seem like they have an infectious cause of the exacerbation, then you should probably give higher-dose steroids up front rather than being cautious and underdosing,” he said.

Investigators now plan additional analyses focused specifically on steroid exposure during the first 48 to 72 hours of hospitalization.

“Does giving a higher-dose steroid in those first 48 to 72 hours lead to changes in outcomes or shorter length of stay?” Moore wondered.

Editor’s note: Moore has no reported disclosures.

References

Moore J, Kurtzman A, Garapati A, et al. (Poster Board # P811) Higher Corticosteroid Dose Linked to Shorter Hospitalization in Acute Exacerbations of Systemic Autoimmune Related Disease Associated Interstitial Lung Disease. Poster presented at ATS 2026 in Orlando, Florida, on May 17.