Colchicine, D-Penicillamine, and Prednisone in the Treatment of Idiopathic Pulmonary Fibrosis: Semiquantitative Histologic Assessment
Semiquantitative Histologic Assessment
The percentage of fibrosis and inflammation in lung samples was analyzed as described elsewhere. Briefly, the assessment was done on the slide scanned completely in zigzag fashion, first at X32 and then at X125 magnification. In all cases, four slides, two of them stained with Masson’s trichrome and two with hematoxylin-eosin, were analyzed. The percentage of fibrosis and inflammation was expressed in multiples of 10. Intraobserver reproducibility was evaluated using the weighted kappa statistic and was of 0.58±0.13 (p<0.0001).
Pulmonary Function Tests
Spirometry was performed using electronic integration of a pneumotachometer signal (Erich jaeger GmbH & CoKG; Wurzburg, Federal Republic of Germany). Three acceptable FVC maneuvers were obtained from each patient and the best FEVX and FVC were chosen. Canadian drug mall comments Total lung capacity (TLC) and residual volume were derived from functional residual capacity that was measured in a constant volume plethysmograph (Jaeger Bodytest; Erick Jaeger GmbH & CoKG). Spirometric measurements and the subdivisions of lung volume were expressed as percent of predicted using the reference equations by Quanjer. PaO£ and PaC02 were also recorded.
Treatment Protocol and Follow-up
Patients were assigned into four groups: group 1 (n=15)— prednisone; group 2 (n = 19)—prednisone and colchicine; group 3 (n=ll)—prednisone plus D-penicillamine; and group 4 (n = ll)—prednisone, colchicine, and D-penicillamine.
In all groups, prednisone was given at a initial dose of 1.0 mg/kg/d for 1 month followed by a reduction of 5 mg/d every 2 weeks until a maintenance dose of 15 to 20 mg/d was reached. The four groups received oral prednisone according to an identical protocol. Colchicine was administered at a daily dose of 1.0 mg, and D-penicillamine was given at a daily dose of 600 mg. In all groups, treatment was prolonged during all the time of follow-up.