A critical assessment of treatment options for idiopathic pulmonary fibrosis

Nirav R. Shah, Paul Noble, Robert M. Jackson, Talmadge E. King, Steven D. Nathan, Maria Padilla, Ganesh Raghu, Melissa Bruce Rhodes, Marvin Schwarz, Gregory Tino, Robert W. Dubois

Research output: Contribution to journalReview article

26 Scopus citations

Abstract

Background: To date, no management approach has proven to be efficacious for the treatment of idiopathic pulmonary fibrosis (IPF). Consequently, therapeutic options remain controversial and confusing for many clinicians. We sought to formally review available evidence on treatment options for IPF and to have a diverse panel of physicians rate the "appropriateness," "inappropriateness," or "uncertainty" of some of the available therapeutic options. Methods: The RAND/UCLA Appropriateness Method was used to review and rate multiple clinical scenarios for the treatment of IPF. The panel was composed of nine physicians from geographically diverse areas who received a systematic review on the risks and benefits of commonly used treatments for IPF as background. Results: A total of 324 clinical scenarios were rated: 25% as appropriate; 39%, uncertain; and 36%, inappropriate. The panel disagreed about 12% of the therapy indications in the final ratings, falling from 26% in the first-round ratings. Conclusions: Key themes emerged from the consensus process. Lacking evidence for a definitive therapy, it was considered most appropriate to enroll eligible patients in clinical trials and refer eligible patients for transplant evaluation. For patients without access to clinical trials, the committee was not unanimous regarding treatment recommendations. It was considered inappropriate for patients with a confident diagnosis of IPF to be treated with corticosteroids as the sole agent: corticosteroids should be used in conjunction with azathioprine. With progressive disease despite such combination use, there was agreement for the use of interferon gamma-1b in patients unwilling or unable to participate in available clinical trials.

Original languageEnglish (US)
Pages (from-to)167-174
Number of pages8
JournalSarcoidosis Vasculitis and Diffuse Lung Diseases
Volume22
Issue number3
StatePublished - Oct 1 2005
Externally publishedYes

Keywords

  • Adult
  • Fibrosing alveolitis
  • Human
  • Interstitial pneumonia
  • Pulmonary fibrosis
  • Therapeutics

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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  • Cite this

    Shah, N. R., Noble, P., Jackson, R. M., King, T. E., Nathan, S. D., Padilla, M., Raghu, G., Rhodes, M. B., Schwarz, M., Tino, G., & Dubois, R. W. (2005). A critical assessment of treatment options for idiopathic pulmonary fibrosis. Sarcoidosis Vasculitis and Diffuse Lung Diseases, 22(3), 167-174.