第2巻 2006年10月　第4号

■綜説

特発性肺線維症の治療最前線
吾妻　安良太
日本医科大学大学院医学研究科呼吸器感染腫瘍内科学

Recent Topics in Treatment for Idiopathic Pulmonary Fibrosis
Arata Azuma
Department of Pulmonary Medicine/Infection and Oncology, Nippon Medical School Graduate School of Medicine

Idiopathic pulmonary fibrosis (IPF) is a devastating and fatal disease of unknown etiology. Survival of IPF is estimated at 3 to 4 years from first medical assessment for idiopathic interstitial pneumonias (IIPs). Currently, available therapies for IPF include corticosteroid and immunosuppressant for anti-inflammatory actions unfortunately no improvements were noted for the survival of IPF. Recently, several clinical studies report on the antifibrotic outcomes for new agents of IPF. Pirfendione, Interferon (IFN)-γ, and N-acetylcysteine (NAC) are promising agents for IPF.
We confirmed the efficacy of pirfenidone as a significant inhibitor for the deterioration of pulmonary functions and for decreasing the number of patients with acute exacerbations during a well designed, double blind placebo controlled randomized clinical trial in Japan. Furthermore, we adopted new methods for assessing dynamic pulmonary function by measuring minimum values of desaturation during 6 minutes walking at constant speed. Interstitial pneumonia in patients with Hermansky-Pudlak syndrome has been treated with pirfenidone in US. Pirfenidone successfully prevents worsening of %FVC for patients with %FVC>60%, but not for the group %FVC≤60%.
Treatment with IFN-γ for IPF has been conducted in North America, but IFN-γ could not improve progression-free survival for the intent-to-treat group. However, IFN-γ significantly decreased the mortality ratio in patients with %FVC>60%.
Recently, the evaluation of effective drugs for IPF has focused on dynamic pulmonary functions such as 6 minutes walk test, as pathological evaluation of IIPs is not recognized as a gold standard for estimating survival of patients with IPF.
In this review, we introduce new strategies for the evaluation, and compounds for the treatment of IPF.

日医大医会誌 2006; 2(4), 192-201

Key words
idiopathic pulmonary fibrosis (IPF), pirfenidone, interferon-γ, N acetylcysteine, 6 minutes walking test

Correspondence to
Arata Azuma, Department of Pulmonary Medicine/Infection and Oncology, Nippon Medical School Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
E-mail：a-azuma@nms.ac.jp

受付：2006年7月31日　受理：2006年9月22日