Anti-cytokine therapy in fibrosing alveolitis: where are we now?
Idiopathic pulmonary fibrosis (IPF) is a condition that has a poor prognosis, with a median survival of 4-5 years irrespective of treatment. Ziesche et al (N Engl J Med 1999, 341: 1264-1269) describe an open randomised trial of 18 patients with IPF, unresponsive to corticosteroid treatment at high dose. Nine patients were treated with continued corticosteroid and nine with prednisolone plus interferon-gamma 1b (IFN-gamma). Significant benefits in physiological parameters are reported in the IFN-gamma-treated group. An analysis of lung tissue by reverse-transcriptase-mediated polymerase chain reaction showed corresponding decreases in the transcription of transforming growth factor-beta1 and connective tissue growth factor. This is the first report of treatment showing efficacy in this disease, albeit in a very preliminary study, but the data should be viewed with caution. This study is discussed in the context of other published studies of treatment for IPF and the scientific rationale on which it was based.
Millar
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Lung Research Group, University of Bristol Medical School, Southmead Hospital, Westbury on Trym, Bristol, UK. ann.millar@bristol.ac.uk
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D016207:Cytokines / Q000037:antagonists & inhibitors*; D004359:Drug Therapy, Combination; D006801:Humans; D007371:Interferon-gamma / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D011658:Pulmonary Fibrosis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins; D019233:Retreatment; D017211:Treatment Failure
D000305:Adrenal Cortex Hormones; D016207:Cytokines; D011994:Recombinant Proteins; D007371:Interferon-gamma; D011239:Prednisolone