{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:01:47Z","timestamp":1790776907423,"version":"4.1.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) has high short-term mortality, yet guidelines weakly recommend corticosteroids without defining dose or duration. Pulse-dose methylprednisolone is widely used despite minimal evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To test the superiority of a pulse-dose corticosteroid regimen over a nonpulse regimen with respect to short-term survival in AE-IPF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this randomised, open-label, multicenter trial at eight South Korean university hospitals, adults with AE-IPF were assigned (1:1) to receive either intravenous pulse methylprednisolone (10\u2009mg\/kg for 3 days) or nonpulse regimen (1\u2009mg\/kg for 7 days), followed by protocolised tapering and maintenance low-dose prednisolone. Primary outcomes were all-cause mortality at 28 and 90 days. Secondary outcomes included intensive care unit admission, use of mechanical ventilation or extracorporeal membrane oxygenation, death or lung transplantation at 28 and 90 days, and adverse events. The trial was registered at ClinicalTrials.gov, NCT04996303.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>From July 2021 to April 2024, 100 patients were randomised (pulse n\u2009=\u200951; nonpulse n\u2009=\u200949). The pulse regimen did not demonstrate lower 28-day mortality than the nonpulse regimen (10.0% vs. 14.6%; risk difference, \u20134.6 percentage points; 95% CI, \u201318.8 to 9.1; P\u2009=\u20090.549) or lower 90-day mortality (24.5% vs. 29.8%; risk difference, \u20135.3 percentage points; 95% CI, \u201323.1 to 12.6; P\u2009=\u20090.648). Treating transplantation as a competing event, Fine\u2013Gray analysis did not demonstrate a difference in 90-day mortality. Secondary outcomes were not demonstrably different between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among adults with AE-IPF, pulse-dose methylprednisolone did not demonstrate improved 28- or 90-day survival compared with a nonpulse corticosteroid regimen.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajrccm\/aamag529","type":"journal-article","created":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T11:33:26Z","timestamp":1790508806000},"source":"Crossref","is-referenced-by-count":0,"title":["Pulse versus Nonpulse Corticosteroid Therapy in Acute Exacerbation of Idiopathic Pulmonary Fibrosis: A Multicenter, Randomized Clinical Trial (SAFER)"],"prefix":"10.1093","author":[{"given":"Hyesoo","family":"Kim","sequence":"first","affiliation":[{"name":"Inha University College of Medicine Division of Pulmonology, Department of Internal Medicine, , Incheon,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye Jin","family":"Jang","sequence":"additional","affiliation":[{"name":"Inha University College of Medicine Division of Pulmonology, Department of Internal Medicine, , Incheon,","place":["Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Song Yee","family":"Kim","sequence":"additional","affiliation":[{"name":"Severance Hospital, Yonsei University College of Medicine Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Seoul, Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"La Woo","sequence":"additional","affiliation":[{"name":"Severance Hospital, Yonsei University College of Medicine Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Seoul, Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Severance Hospital, Yonsei University College of Medicine Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Seoul, Republic of","place":["Korea"]},{"name":"Yongin Severance Hospital, Yonsei University College of Medicine Division of Pulmonology and Allergy, Department of Internal Medicine, , Yongin, Gyeonggi Province, Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Se Hyun","family":"Kwak","sequence":"additional","affiliation":[{"name":"Severance Hospital, Yonsei University College of Medicine Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Seoul, Republic of","place":["Korea"]},{"name":"Yongin Severance Hospital, Yonsei University College of Medicine Division of Pulmonology and Allergy, Department of Internal Medicine, , Yongin, Gyeonggi Province, Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Hye","family":"Lee","sequence":"additional","affiliation":[{"name":"Severance Hospital, Yonsei University College of Medicine Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Seoul, Republic of","place":["Korea"]},{"name":"Yongin Severance Hospital, Yonsei University College of Medicine Division of Pulmonology and Allergy, Department of Internal Medicine, , Yongin, Gyeonggi Province, Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Soo","family":"Choi","sequence":"additional","affiliation":[{"name":"Severance Hospital, Yonsei University College of Medicine Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Seoul, Republic of","place":["Korea"]},{"name":"Yongin Severance Hospital, Yonsei University College of Medicine Division of Pulmonology and Allergy, Department of Internal Medicine, , Yongin, Gyeonggi Province, Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Kwang","family":"Byun","sequence":"additional","affiliation":[{"name":"Severance Hospital, Yonsei University College of Medicine Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Seoul, Republic of","place":["Korea"]},{"name":"Gangnam Severance Hospital, Yonsei University College of Medicine Division of Pulmonology, Department of Internal Medicine, , Seoul, Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Severance Hospital, Yonsei University College of Medicine Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Seoul, Republic of","place":["Korea"]},{"name":"Gangnam Severance Hospital, Yonsei University College of Medicine Division of Pulmonology, Department of Internal Medicine, , Seoul, Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iseul","family":"Yu","sequence":"additional","affiliation":[{"name":"Yonsei University Wonju College of Medicine Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, , Wonju, Gangwon Province, Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Youl","family":"Lee","sequence":"additional","affiliation":[{"name":"Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, , Chuncheon, Gangwon Province, Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Hoon","family":"Han","sequence":"additional","affiliation":[{"name":"National Health Insurance Service Ilsan Hospital Division of Pulmonology, Department of Internal Medicine, , Goyang, Gyeonggi Province, Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seon Cheol","family":"Park","sequence":"additional","affiliation":[{"name":"National Health Insurance Service Ilsan Hospital Division of Pulmonology, Department of Internal Medicine, , Goyang, Gyeonggi Province, Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Ho","family":"Chung","sequence":"additional","affiliation":[{"name":"International St. Mary's Hospital, Catholic Kwandong University College of Medicine Department of Internal Medicine, , Incheon, Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Eun","family":"Park","sequence":"additional","affiliation":[{"name":"Ajou University School of Medicine Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Suwon, Gyeonggi Province, Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Won","family":"Park","sequence":"additional","affiliation":[{"name":"Ajou University School of Medicine Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Suwon, Gyeonggi Province, Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang-Ha","family":"Kim","sequence":"additional","affiliation":[{"name":"Yonsei University Wonju College of Medicine Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, , Wonju, Gangwon Province, Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganesh","family":"Raghu","sequence":"additional","affiliation":[{"name":"University of Washington Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, and Department of Laboratory Medicine and Pathology, , Seattle, WA,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moo Suk","family":"Park","sequence":"additional","affiliation":[{"name":"Severance Hospital, Yonsei University College of Medicine Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, , Seoul, Republic of","place":["Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the SAFER Trial Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M S","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S Y","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A L","family":"Woo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E Y","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H J","family":"Jang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H S","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M K","family":"Byun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C Y","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S H","family":"Kwak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E H","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J S","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S H","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I S","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C H","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S C","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J H","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C Y","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J E","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J W","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,30]]},"container-title":["American Journal of Respiratory and Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajrccm\/advance-article-pdf\/doi\/10.1093\/ajrccm\/aamag529\/71522992\/aamag529.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajrccm\/advance-article-pdf\/doi\/10.1093\/ajrccm\/aamag529\/71522992\/aamag529.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:42:13Z","timestamp":1790775733000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajrccm\/advance-article\/doi\/10.1093\/ajrccm\/aamag529\/8853809"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/ajrccm\/aamag529","relation":{},"ISSN":["1073-449X","1535-4970"],"issn-type":[{"value":"1073-449X","type":"print"},{"value":"1535-4970","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"article-number":"aamag529"}}