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Pulmonary Medicine
Volume 2011, Article ID 240805, 5 pages
http://dx.doi.org/10.1155/2011/240805
Clinical Study

Ganciclovir Antiviral Therapy in Advanced Idiopathic Pulmonary Fibrosis: An Open Pilot Study

1Advanced Lung Disease and Lung Transplant Programme, Department of Respiratory Medicine, Mater Misericordiae University Hospital, University College Dublin, Eccles Street, Dublin 7, Ireland
2Respiratory Research Group, University of Manchester, Manchester Academic Health Sciences Centre, UK
3Division of Medical Microbiology and Genitourinary Medicine, University of Liverpool, UK
4NIHR Translational Research Facility in Respiratory Medicine, University Hospital of South Manchester, UK

Received 27 October 2010; Accepted 7 February 2011

Academic Editor: Patrick Mallia

Copyright © 2011 J. J. Egan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hypothesis. Repeated epithelial cell injury secondary to viruses such as Epstein Barr and subsequent dysfunctional repair may be central to the pathogenesis of IPF. In this observational study, we evaluated whether a combination of standard and anti-viral therapy might have an impact on disease progression. Methods. Advanced IPF patients who failed standard therapy and had serological evidence of previous EBV, received ganciclovir (iv) at 5 mg/kg twice daily. Forced vital capacity (FVC), shuttle walk test, DTPA scan and prednisolone dose were measured before and 8 weeks post-treatment. Results. Fourteen patients were included. After ganciclovir, eight patients showed improvement in FVC and six deteriorated. The median reduction of prednisolone dose was 7.5 mg (44%). Nine patients were classified “responders” of whom four showed an improvement in all four criteria, while three of the five “non-responders” showed no response in any of the criteria. Responders showed reduction in prednisolone dosage ( ) and improved DTPA clearance ( ). Conclusion. This audit outcome suggests that 2-week course of ganciclovir (iv) may attenuate disease progression in a subgroup of advanced IPF patients. These observations do not suggest that anti-viral treatment is a substitute for the standard care, however, suggests the need to explore the efficacy of ganciclovir as adjunctive therapy in IPF.