Triple therapy in idiopathic pulmonary fibrosis: an alarming press release.

O n October 21, 2011, the National Heart, Lung, and Blood Institute (NHLBI), announced by press release that the prednisolone/azathioprine/N-acetylcysteine (triple therapy) arm of the PANTHER study (Prednisone, Azathioprine and N-acetylcysteine: a Study That Evaluates Response in IPF) had been discontinued [1]. Compared with patients receiving placebo, patients with idiopathic pulmonary fibrosis (IPF) treated with triple therapy had excess deaths (11% versus 1%), more hospitalisations (29% versus 8%) and a higher prevalence of serious adverse events (31% versus 9%). The study is continuing with the N-acetylcysteine and placebo arms only. No concerns have been raised as a result of preliminary analysis of the N-acetylcysteine monotherapy arm of the PANTHER study. The preliminary announcement by the NHLBI has no immediate implications with regard to the introduction or continuation of N-acetylcysteine in IPF.