title: Double-blind controlled trial of lecithinized superoxide dismutase in patients with idiopathic interstitial pneumonia - short term evaluation of safety and tolerability.
abstract: BACKGROUND
  Idiopathic interstitial pneumonias such as idiopathic pulmonary fibrosis or fibrotic nonspecific interstitial pneumonia are irreversible progressive pulmonary diseases that often have fatal outcomes. Although the etiology of idiopathic interstitial pneumonias is not yet fully understood, anti-fibrotic and anti-inflammatory agents have shown limited therapeutic effectiveness. Reactive oxygen species and their cytotoxic effects on the lung epithelial cells have been reported to participate in the pathophysiology of the disease. Because superoxide dismutase catalyzes the detoxification of reactive oxygen species, we developed lecithinized superoxide dismutase for the treatment of patients with idiopathic interstitial pneumonias.
  
  
  METHODS
  A multicenter, randomized, placebo-controlled trial was conducted as a pilot study to investigate the safety and effectiveness of 40 or 80 mg lecithinized superoxide dismutase in patients with progressive idiopathic interstitial pneumonias who presented with either idiopathic pulmonary fibrosis or corticosteroid-resistant fibrotic nonspecific interstitial pneumonia and showed arterial oxygen tension compatible with stage III or IV on the Japanese severity grading scale for idiopathic interstitial pneumonias. Before and following infusion of lecithinized superoxide dismutase for 28 days, the primary endpoint of forced vital capacity and the secondary endpoints of lactate dehydrogenase, surfactant protein-A, surfactant protein-D and Krebs von den Lungen-6 levels were measured in the serum.
  
  
  RESULTS
  The primary endpoint of forced vital capacity did not improve significantly in the lecithinized superoxide dismutase groups in comparison with the placebo group. The secondary endpoints of lactate dehydrogenase and surfactant protein-A levels were significantly attenuated by 28 days in the higher-dose (80 mg) group. However, these changes returned to the baseline levels by 56 days after the cessation of lecithinized superoxide dismutase. Adverse events and mortality in the drug-treated groups did not differ from those in the placebo group.
  
  
  CONCLUSIONS
  Treatment with lecithinized superoxide dismutase is safe and improves the levels of serum markers such as lactate dehydrogenase and surfactant protein-A in patients with advanced idiopathic interstitial pneumonias with severe respiratory dysfunction. Considering the results of the current study, further investigations into the effects and treatment potential of long-term administration of lecithinized superoxide dismutase may be warranted.
  
  
  BACKGROUND
  University hospital Medical Information Network (UMIN) clinical trials registry no. 000000752.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kamio
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. a-azuma@nms.ac.jp.
authors.forename: Arata
authors.initials: A
authors.lastname: Azuma
authors.forename: Ken
authors.initials: K
authors.lastname: Ohta
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Sugiyama
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nukiwa
authors.forename: Shoji
authors.initials: S
authors.lastname: Kudoh
authors.forename: Tohru
authors.initials: T
authors.lastname: Mizushima
mesh_terms: D000704:Analysis of Variance; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054988:Idiopathic Interstitial Pneumonias / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D008297:Male; D020714:Maximum Tolerated Dose; D061214:Patient Safety; D010713:Phosphatidylcholines / Q000009:adverse effects / Q000627:therapeutic use*; D010865:Pilot Projects; D011658:Pulmonary Fibrosis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D012016:Reference Values; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D013482:Superoxide Dismutase / Q000009:adverse effects / Q000627:therapeutic use*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010713:Phosphatidylcholines; D013482:Superoxide Dismutase; C434045:lecithinized superoxide dismutase