[New treatment options for idiopathic pulmonary fibrosis?]

Idiopathic pulmonary fibrosis (IPF) is a chronic condition of unknown etiology with an life-limiting outcome. An excess of profibrotic and proinflammatory mediators as well as reactive oxygen species, resulting in progressive fixed tissue fibrosis, architectural distortion and loss of lung function making it plausible to inhibit these processes therapeutically. In this review new treatment options are discussed including substances with antiinflammatory properties which inhibit cytokines, eicosanoids or oxidants, drugs with antifibrotic efficacy as well as anticoagulative compounds. In the last 5 years treatment trials include only IPF patients characterized by the criteria of the American Thoracic Society and the European Respiratory Society. However, lack of validated outcome measures in most trials representing either disease improvement or progression, and/or sufficient large patient number are still hindering this kind of studies. Unfortunately most studies still failed to meet their primary end-points. Marginal trends or statistically significant differences between treatment groups were only apparent in subgroups or exploratory end-points of post-hoc analysis. Regardless of numerous trails published in recent years and per se promising new drugs, a change in current recommendations in the management of IPF is not warranted at present.