Colchicine, D-Penicillamine, and Prednisone in the Treatment of Idiopathic Pulmonary Fibrosis: Conclusion
In general, the results of this study strongly suggest that neither colchicine nor D-penicillamine contributed to a better clinical response compared with prednisone alone. This finding could be at least partially explained by the advanced stage of the disease in most of our patients at the initial evaluation (average of FVC<50%; average of Pa02<50 mm Hg at 2,240-m altitude). Thus, for example, these initial functional test results are markedly worse than those displayed by the patients in the Mayo Clinic Rochester study. Therefore, we cannot rule out that colchicine or D-penicillamine might have some beneficial effect on IPF patients if they are treated in early stages of the disease.
In addition to the presence of advanced lung disease at the time of diagnosis, hypoxemia due to altitude is another likely explanation for the excess mortality. The patients of this study used to live in Mexico City located at 2,240-m altitude. In this context, we have previously found that the survival in patients with chronic hypersensitivity pneumonitis and IPF living in the valley of Mexico is considerably worse than patients reported in developed countries at sea level in detail canadian pharmacy levitra. In addition, our patients cannot have long-term home oxygen therapy due to its cost.
Although we could not find differences in mortality or other indicators among treatments, we did easily for adverse effects by individual drugs. As expected, the known side effects of prednisone were more serious, whereas colchicine and D-penicillamine were well tolerated.
In summary, our findings suggest that prednisone alone does not prevent a progressive decline in the natural course of IPF, and did not support the assumption that colchicine or D-penicillamine may add some beneficial effect. Further studies with large numbers of patients and in earlier stages of the disease are necessary to have stronger evidence to make clinical recommendations. Nevertheless, the search for new drugs capable of modifying the natural history of the fibrotic lung disorders is imperative.