Chest
Volume 114, Issue 2, August 1998, Pages 507-512
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Clinical Investigations: Idiopathic Disease
Colchicine, D-Penicillamine, and Prednisone in the Treatment of Idiopathic Pulmonary Fibrosis: A Controlled Clinical Trial

https://doi.org/10.1378/chest.114.2.507Get rights and content

Study objective

We compared the long-term efficacy of the combination of colchicine and/or D-penicillamine with prednisone, in comparison to prednisone alone in patients with idiopathic pulmonary fibrosis (IPF).

Design

Nonrandomized prospective study in patients with IPF confirmed by biopsy specimen.

Setting

National Institute of Respiratory Diseases, Mexico.

Patients

Fifty-six IPF patients were included in this study. Patients received either colchicine/prednisone (n=19), D-penicillamine/prednisone (n=11), D-penicillamine/colchicine/prednisone (n=11), or prednisone alone (n=15). Prednisone therapy was started at 1.0 mg/kg/d for 1 month followed by a biweekly taper to a maintenance dose of 15 mg/d. Colchicine was administered at a daily dose of 1.0 mg, and D-penicillamine was given at a daily dose of 600 mg.

Measurements and results

Response to therapy was assessed by changes in lung function test results as measured by total and vital lung capacities, arterial blood gas analysis at rest breathing room air, and survival. No significant differences either in lung mechanics or in arterial gases were found in any group relative to the baseline measurement. Thirteen of the 56 patients died during the first 2 years, and 29 were dead at 5 years follow-up. Comparison of survival curves by Cox regression model showed no statistically significant difference among the four groups. Known side effects attributable to prednisone were more common and severe than those attributable to the other drugs.

Conclusions

Our results suggest that neither colchicine nor D-penicillamine modified the progressive course of prednisone-treated IPF, and that the search for new drugs is imperative.

Section snippets

Study Population

Fifty-six adult patients with clinical, radiologic, and functional features of interstitial lung disease and histologically proven diagnosis of IPF were enrolled in this prospective study. The patients were seen at the National Institute of Respiratory Diseases in Mexico City between 1983 and 1990, and the protocol was approved by the corresponding Scientific and Ethical Committees. Diagnosis of IPF was suspected in patients with progressive dyspnea, diffuse reticulonodular infiltrates on chest

Results

Baseline characteristics of the four groups are summarized in Table 1. Dyspnea score and pulmonary function test results were comparable among the groups. Younger patients were located in group 4 who received prednisone, colchicine, and D-penicillamine when compared with the prednisone and prednisone plus colchicine groups (p<0.05). Five patients were unavailable during the 5-year follow-up. The end points examined for therapeutic outcome were measurable change in dyspnea score, lung function

Discussion

IPF represents a prototype of an aggressive and usually progressive interstitial lung disease that continues being a therapeutic problem for the clinician.

Corticosteroids are currently the recommended pharmacologic therapy, mainly with the rationale of stabilizing or preventing disease progression by suppression of the chronic inflammation. However, their long-term benefits are questionable. Thus, although a number of patients treated with corticosteroids feel better, results of objective

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