Colchicine, D-Penicillamine, and Prednisone in the Treatment of Idiopathic Pulmonary Fibrosis: Outcome
Colchicine has been successfully used in the treatment of human liver fibrosis and importantly, it mediates its effect at doses that are tolerated in vivo. The drug binds microtubular proteins interrupting cellular mitosis, and thus inhibits collagen biosynthesis. Canadian health&care mall more Additionally, it stimulates collagenase activity and inhibits the release of some fibroblast growth and chemotactic factors, and then limits fibroblast expansion in the lung parenchyma. All these effects, and the low incidence of ordinarily moderate side effects, make this drug an excellent candidate for the therapy of human fibrotic disorders.
In this context, colchicine, as either a single drug or combined with corticosteroids, has claimed to be at least as effective as immunosuppressive agents in the treatment of IPF, but studies have been retrospective, uncontrolled, and with short follow-up. With these precedents, we designed this project to test the possible usefulness of the combination of colchicine or/and D-penicillamine with prednisone in the prognosis of IPF patients.
It is important to emphasize that the design of therapeutic trials in patients with IPF faces several important problems. Although the disease is usually a lethal condition, the conditions of individual patients may initially improve with corticosteroids or cytotoxic drugs. Therefore, although a recent study suggested that as a group patients with steroids have the same survival rate as those who did not receive therapy, at the time that our study started, it was unethical to include a placebo group. The study also lacks the random allocation of the patients that could explain some of the differences among groups. Additionally, the number of subjects is also relatively reduced and therefore we cannot rule out differences in improvements offered by the tested treatments. Despite these shortcomings, we consider that the data are important and offer valuable information.