Evaluating the Effectiveness of Prednisone, Azathioprine, and N-acetylcysteine in Patients With IPF
Condition: Pulmonary Fibrosis
MeSH terms: Pulmonary Fibrosis; Fibrosis
Intervention: N-acetylcysteine (NAC); Placebo
Intervention description: Participants will receive 600 mg of NAC three times a day.; Participants will receive placebo each day.
Intervention MeSH terms: Acetylcysteine; N-monoacetylcystine
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Enrollment: 264.0
Sex: All
Minimum age: 35 Years
Maximum age: 85 Years
Healthy volunteers: No
Keywords: Idiopathic Pulmonary Fibrosis; Prednisone; Azathioprine; NAC; N-acetylcysteine

Summary:

      Idiopathic pulmonary fibrosis (IPF) is a long-term lung disease that affects an individual's
      ability to breathe. In this randomized, double-blind, placebo-controlled trial, we assigned
      patients with idiopathic pulmonary fibrosis who had mild-to-moderate lung-function impairment
      to one of three groups - receiving a combination of prednisone, azathioprine, and NAC
      (combination therapy), NAC alone, or placebo - in a 1:1:1 ratio.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Forced vital capacity (FVC) greater than or equal to 50% of predicted value

          -  Diffusion capacity (DLCO) greater than or equal to 30% of predicted value

          -  Diagnosis of IPF by modified American Thoracic Society (ATS) criteria in the 48 months
             before study entry

        Exclusion Criteria:

          -  History of clinically significant environmental exposure known to cause pulmonary
             fibrosis

          -  Diagnosis of connective tissue disease as the likely cause of the interstitial disease

          -  Extent of emphysema greater than the extent of fibrotic change (i.e., honeycombing,
             reticular changes) on high resolution computed tomography (HRCT) scan

          -  Forced expiratory volume in 1 second (FEV1)/FVC ratio less than 0.65 at the time of
             screening (post-bronchodilator)

          -  Partial pressure of arterial oxygen (PaO2) less than 55 mm Hg (less than 50 mm Hg at
             Denver study site)

          -  Residual volume greater than 120% predicted at the time of screening
             (post-bronchodilator)

          -  Evidence of active infection

          -  Significant bronchodilator response on screening spirometry, defined as change in FEV1
             greater than or equal to 12% and absolute change greater than 200 mL OR change in FVC
             greater than or equal to 12% and absolute change greater than 200 mL

          -  Screening and baseline FVC measurements (in liters, post-bronchodilator) differing by
             11%

          -  Listed for lung transplantation

          -  History of unstable or deteriorating cardiac disease

          -  Heart attack, coronary artery bypass, or angioplasty in the 6 months before study
             entry

          -  Unstable angina pectoris or congestive heart failure requiring hospitalization in the
             6 months before study entry

          -  Uncontrolled arrhythmia

          -  Severe uncontrolled high blood pressure

          -  Known HIV or hepatitis C

          -  Known cirrhosis and chronic active hepatitis

          -  Active substance and/or alcohol abuse

          -  Pregnant or breastfeeding

          -  Women of childbearing potential who are not using a medically approved means of
             contraception

          -  Any clinically relevant lab abnormalities, including the following:

               1. Creatinine greater than twice the upper limit of normal (ULN)

               2. Hematology outside of specified limits

                    1. White blood cells less than 3,500/mm3

                    2. Hematocrit less than 25% or greater than 59%

                    3. Platelets less than 100,000 mm3 at the time of screening

               3. Any of the following liver function test criteria above specified limits

                    1. Total bilirubin greater than twice the ULN

                    2. Aspartate (AST) or alanine aminotransferases (ALT) greater than 1.5 the ULN

                    3. Alkaline phosphatase greater than three times the ULN

                    4. Albumin less than 3.0 mg/dL at the time of screening

          -  Known hypersensitivity to study medication

          -  Any condition other than IPF that, in the opinion of the site PI, is likely to result
             in death in the 1 year after study entry

          -  Any condition that, in the judgment of the PI, might cause participation in this study
             to be detrimental or makes the person a poor candidate for the study