© 2003 American Thoracic Society
A possible antiinflammatory treatment for cystic fibrosisTo the Editor:The recent editorial by Dr. Berger (1) challenged us to find new antiinflammatory therapies that can safely dampen the excessive inflammatory response in the cystic fibrosis lung. The anti-malarial drug, chloroquine, has antiinflammatory properties and has not, to my knowledge, been tested clinically in the treatment of cystic fibrosis. Because of its antiinflammatory properties, chloroquine has been used to treat rheumatic disease, for which it may have a better risk/benefit ratio than ibuprofen (2). Chloroquine may also greatly increase the survival of children with interstitial pneumonitides, including those resistant to steroid treatment (3). One in vitro study suggests that chloroquine may partially normalize the airway surface in cystic fibrosis, and consequently decrease bacterial adherence to that surface (4). Chloroquine has a long history of use in many clinical settings, so its risks are well known and are relatively tolerable. For these reasons, a clinical trial of chloroquine treatment on cystic fibrosis may be warranted. Other anti-malarial medications might also be considered for such a trial.
Mayo Clinic, Rochester, Minnesota REFERENCES
From the Author: I am glad that Dr. Derleth has taken up the challenge made in my editorial (1). I strongly agree that antiinflammatory drugs with which we have experience in rheumatic diseases should be considered to determine if they might be useful in combatting the excessive inflammation that destroys the lung in cystic fibrosis. However, a number of concerns might make anti-malarials like chloroquine and hydroxychloroquine less than ideal. In particular, since the mechanisms by which these drugs exert their salutary effects in rheumatic disorders are poorly understood, their half-lives are very long, and their potential toxicities (i.e., retinopathy and/or corneal damage) require monitoring by an additional medical specialist not already involved in comprehensive care of the cystic fibrosis patient (ophthalmologists), it does not seem likely that they will gain wide acceptance. A 1999 survey found that antiinflammatory therapy was routinely prescribed for only 25% of cystic fibrosis patients, with concerns over long-term safety and monitoring requirements frequently cited as reasons for physicians' reluctance to use available therapies (2). Prolonged clinical trials will almost certainly be necessary to establish the safety and efficacy of antiinflammatory drugs in this patient population, and experience in patients with other inflammatory diseases should be an important factor in selecting agents to be tested, since it is not likely that many such trials will be carried out.
Case Western Reserve University Cleveland, Ohio REFERENCES
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