Cytotoxic Drug Therapy for Diffuse ILD

Department of Medicine, Interstitial Lung Disease and Sarcoidosis Clinic, University of Cincinnati, Cincinnati, Ohio, U.S.A. 

Margaret Turner-Warwick was one of the first to study cyclophosphamide (CP) to treat idiopathic pulmonary fibrosis (IPF) (3). Her group report completed a double-blind randomized trial of CP for IPF, which identified several of the issues that still plague current trials in this area, including the high mortality of the disease and the apparent lack of response in patients with more severe disease at time of starting treatment (4). 

For sarcoidosis, early studies by Dr. Harold Israel demonstrated the steroid-sparing properties of various cytotoxic agents such as methotrexate (MTX), 

This chapter will discuss the several agents that have been proposed for potential therapy for various diffuse lung diseases. Table 1 lists the agents to be discussed in general classes. Examples of the use of these drugs for specific ILDs are cited in the table. In most cases, the role of these drugs remains unclear. In fact, the value of any treatment for IFF is controversial (14,15). 

The focus of the chapter is not on the efficacy of individual treatments for the various ILDs but to provide a guideline behind the administration and monitoring. Whenever possible, the information will be derived from studies of pulmonary disease. 

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