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Diagnosis and treatment of idiopathic pulmonary fibrosis 2
Published on October 6, 2015 25 min
A selection of talks on Clinical Practice
Behavioral medicine: what it is and what it does
- Dr. Gina Touch Mercer
- University of Arizona College of Medicine - Phoenix, USA
The history and foundations of medical research ethics
- Prof. Dr. Christian Lenk
- Ulm University, Germany
In terms of treatment, it's important to recognize the fact that over the last decades the community of physicians and patients, stakeholders in pharma companies, they've been trying very hard to find a cure for IPF. In this slide, you'll see all the randomized, controlled trials published so far. Every square is a single study. Every color is a single drug. And the size of the square is proportionate to the number of patients enrolled in that trial. You see that we have been very active. Unfortunately, the vast majority of these trials have been negative. So it doesn't mean that we have given up, because as you will see, recently we have been finally successful, but it's a long story of trials. And now we will review with you some of these trials to better understand where we are and where we have been. What about the beginning of these trials? So you see before year 2000, there were small trials, mostly single-center, and with different drugs in combination. And in those days, there was no real engagement from the pharmaceutical industry. So everything was relying on single investigators.
This is where we were in the year 2000. The American Thoracic Society, together with the European Respiratory Society convened together a group of experts to provide a consensus statement on the diagnosis and the treatment of patients with idiopathic pulmonary fibrosis.
And the recommendation that was based mostly on these small trials and on empirical experience was that patients with IPF should be treated with a combination of corticosteroids and immunosuppressants, namely azathioprine or cyclophosphamide. And this again was based on the results of small single-center trials, but also on the belief that inflammation and immunity were the two major drivers of the disease. So since the year 2000, this has been the recommendation of ATS and ERS, and these guideline have been followed worldwide to treat patients with IPF.