Colchicine Versus Prednisone as Treatment of Usual Interstitial Pneumonia

doi:10.4065/72.3.201

Mayo Clinic Proceedings

Volume 72, Issue 3, March 1997, Pages 201-209

https://doi.org/10.4065/72.3.201 Get rights and content

Objective

To assess the results with colchicine and prednisone as initial single-drug therapy in patients with usual interstitial pneumonia (UIP).

Material and Methods

We reviewed the serial pulmonary function test results in 22 patients with typical clinical and high-resolution computed tomographic features of UIP who were treated with colchicine as initial single-agent therapy and compared them with a group of 22 historical patients with UIP of similar severity diagnosed by open-lung biopsy who were given prednisone as initial single-drug therapy.

Results

No significant difference was detected in the rate of decline of pulmonary function or in the time to “failure” between the two study groups. A trend was suggested for more rapid decline of pulmonary function in the prednisone-treated than in the colchicine-treated group. The design of this study does not allow distinction between a possible beneficial effect of colchicine and a possible adverse effect related to weaning from high-dose prednisone. Colchicine was well tolerated; few side effects other than mild diarrhea were noted in those patients able to take the drug long enough to return for pulmonary function testing at 3 months. In comparison, the side effects of prednisone were more serious and were not always reversible with cessation of therapy.

Conclusion

This study lends further support to the assumption that colchicine may be a satisfactory and less hazardous substitute for prednisone in the treatment of patients with UIP.

Section snippets

PATIENTS AND METHODS

Inclusion Criteria.—Medical records were reviewed to identify patients treated with colchicine or prednisone as initial single-drug therapy for UIP. Patients were included in the study only if they had progressive dyspnea, bibasilar inspiratory crackles, typical chest roentgenograms, PFT results consistent with VIP, either HRCT that showed findings characteristic of UIP or OLB specimens that revealed VIP, and at least one follow-up PFT within 2 years after diagnosis. A “very high probability of

RESULTS

Baseline characteristics of the 22 colchicine-treated patients and 22 prednisone-treated patients are summarized in Table 1. UIP was diagnosed more recently in the colchicine-treated patients (1983 to 1995) than in the prednisonetreated patients (1975 to 1985). A higher percentage of prednisone-treated than colchicine-treated patients underwent OLB (100% versus 23%; P <0.001), and a lower percentage of the prednisone group than of the colchicine group had HRCT (0% versus 95%; P<0.001). Age,

DISCUSSION

In the current study, we found no statistically significant difference in the rate of decline of pulmonary function between patients treated with colchicine and patients receiving prednisone as a single initial agent. A trend for a more rapid decline of pulmonary function and for a greater proportion of patients experiencing a significant (as defined by ATS criteria) decline of pulmonary function during the first 2 years in the prednisone-treated than in the colchicine-treated group was

CONCLUSION

This study lends further support to the assumption that colchicine may be a satisfactory substitute for high-dose prednisone in the initial treatment of patients with UIP. This study does not resolve whether results with either colchicine or prednisone differ from results with use of no therapy. Randomized prospective studies of colchicine in the treatment of UIP should be conducted to confirm these preliminary results.

ACKNOWLEDGMENT

We acknowledge, with gratitude, the assistance of Kenneth C. Beck, Ph.D., for retrieving pulmonary function data; Andrew H. Limper, M.D., Ulrich Specks, M.D., and Kenneth P. Offord, M.S., for offering helpful suggestions for this study; our colleagues at Mayo Clinic Rochester, Mayo Clinic Jacksonville, and Mayo Clinic Scottsdale for identifying patients for the colchicine registry; and Gail M. Caron for maintaining the colchicine registry.

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Colchicine Versus Prednisone as Treatment of Usual Interstitial Pneumonia

Objective

Material and Methods

Results

Conclusion

Section snippets

PATIENTS AND METHODS

RESULTS

DISCUSSION

CONCLUSION

ACKNOWLEDGMENT

Chest

Chest

Mayo Clin Proc

J Allergy Clin Immunol

Gastroenterology

Blood

Immuno-pharmacology

Natural history and treated course of usual and desquamative interstitial pneumonia

N Engl J Med

Cryptogenic fibrosing alveolitis: clinical features and their influence on survival

Thorax

Idiopathic pulmonary fibrosis

An immunohistochemical study of architectural remodeling and connective tissue synthesis in pulmonary fibrosis

Am Rev Respir Dis

Idiopathic interstitial pneumonia/idiopathic pulmonary fibrosis

Major Probl Pathol

Disease activity in idiopathic pulmonary fibrosis: CT and pathologic correlation

Radiology

Fibrosing alveolitis: CT-pathologic correlation

Radiology

Accuracy of the typical computed tomographic appearances of fibrosing alveolitis

Thorax

Serial CT in fibrosing alveolitis: prognostic significance of the initial pattern

AJR Am J Roentgenol

Nonspecific interstitial pneumonia/fibrosis: histologie features and clinical significance

Am J Surg Pathol

Cryptogenic fibrosing alveolitis: response to corticosteroid treatment and its effect on survival

Thorax

Randomised controlled trial comparing prednisolone alone with cyclophosphamide and low dose prednisolone in combination in cryptogenic fibrosing alveolitis

Thorax

Azathioprine combined with prednisone in the treatment of idiopathic pulmonary fibrosis: a prospective double-blind, randomized, placebo-controlled clinical trial

Am Rev Respir Dis

Ten-year follow up of 222 patients with idiopathic pulmonary fibrosis (IPF)—a nation-wide survey report in Japan [abstract]

Am Rev Respir Dis

The predictive value of appearances on thin-section computed tomography in fibrosing alveolitis

Am Rev Respir Dis

Corticosteroids in idiopathic pulmonary fibrosis (IPF): toxicity may outweigh benefits [abstract]

Am J Respir Crit Care Med