title: Ganciclovir antiviral therapy in advanced idiopathic pulmonary fibrosis: an open pilot study.
abstract: Hypothesis. Repeated epithelial cell injury secondary to viruses such as Epstein Barr and subsequent dysfunctional repair may be central to the pathogenesis of IPF. In this observational study, we evaluated whether a combination of standard and anti-viral therapy might have an impact on disease progression. Methods. Advanced IPF patients who failed standard therapy and had serological evidence of previous EBV, received ganciclovir (iv) at 5 mg/kg twice daily. Forced vital capacity (FVC), shuttle walk test, DTPA scan and prednisolone dose were measured before and 8 weeks post-treatment. Results. Fourteen patients were included. After ganciclovir, eight patients showed improvement in FVC and six deteriorated. The median reduction of prednisolone dose was 7.5 mg (44%). Nine patients were classified "responders" of whom four showed an improvement in all four criteria, while three of the five "non-responders" showed no response in any of the criteria. Responders showed reduction in prednisolone dosage (P = .02) and improved DTPA clearance (P = .001). Conclusion. This audit outcome suggests that 2-week course of ganciclovir (iv) may attenuate disease progression in a subgroup of advanced IPF patients. These observations do not suggest that anti-viral treatment is a substitute for the standard care, however, suggests the need to explore the efficacy of ganciclovir as adjunctive therapy in IPF.
authors.affiliation: Advanced Lung Disease and Lung Transplant Programme, Department of Respiratory Medicine, Mater Misericordiae University Hospital, University College Dublin, Eccles Street, Dublin 7, Ireland.
authors.forename: J J
authors.initials: JJ
authors.lastname: Egan
authors.forename: H I
authors.initials: HI
authors.lastname: Adamali
authors.forename: S S
authors.initials: SS
authors.lastname: Lok
authors.forename: J P
authors.initials: JP
authors.lastname: Stewart
authors.forename: A A
authors.initials: AA
authors.lastname: Woodcock