The SAFER trial evaluated whether pulse-dose corticosteroids improve short-term survival in acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF). This open-label, multicenter randomized trial enrolled 100 adults across eight university hospitals in South Korea between July 2021 and April 2024. Participants received intravenous methylprednisolone either as pulse therapy (10 mg/kg daily for 3 days; n = 51) or nonpulse therapy (1 mg/kg daily for 7 days; n = 49), followed by protocolized tapering and low-dose prednisolone maintenance.Twenty-eight-day mortality was 10.0% with pulse therapy versus 14.6% with nonpulse therapy (risk difference, −4.6 percentage points; 95% confidence interval [CI], −18.8 to 9.1; p = 0.549).

At 90 days, mortality was 24.5% versus 29.8%, respectively (risk difference, −5.3 percentage points; 95% CI, −23.1 to 12.6; p = 0.648). Secondary outcomes, including…