Combined PEX, Rituximab and Steroids in Acute Idiopathic Pulmonary Fibrosis Exacerbations

This is a prospective, open-label Phase II, non-randomized clinical trial to assess the feasibility and safety of combined plasma exchange (PEX), rituximab, and conventional corticosteroid administration in patients with acute IPF exacerbations.

Inclusion criteria

• A diagnosis of idiopathic pulmonary fibrosis that fulfills American Thoracic Society Consensus Criteria.
• Unexplained worsening or development of dyspnea or hypoxemia within 30 days leading to the current hospitalization.
• Radiographic imaging showing ground-glass abnormality and/or consolidation superimposed on a background of reticular or honeycomb pattern consistent with UIP.
• Intent on the part of the treating physician to use high dose steroid therapy as a therapeutic effort to treat a diagnosis of acute IPF exacerbation.

Exclusion criteria

• Diagnosis of documented infection based upon clinical evaluation and microbial testing.
• Diagnosis of thromboembolic disease by clinical assessment.
• Diagnosis of an additional etiology for ALI/ARDS based upon clinical assessment to include sepsis, aspiration, trauma, inhalational injury, acute pancreatitis, drug toxicity, blood product transfusion reaction, or stem cell transplantation.
• Diagnosis of congestive heart failure that accounts for the hypoxemia.
• Presence of active hepatitis B infection.
• Coagulopathy defined as an INR > 1.8, PTT > 2 x control, and platelet count < 50K.
• Hyperosmolar state or diabetic ketoacidosis to suggest uncontrolled diabetes mellitus or uncontrolled hypertension (systolic BP > 160 mm Hg and diastolic BP > 100 mm Hg) which would contraindicated the use of corticosteroids.
• Hemodynamic instability defined as a vasopressor requirement which would contraindicate the use of plasmapheresis.
• History of reaction to blood products, murine-derived products, or prior exposures to human-murine chimeric antibodies,
• History of malignancy.
• Inability or unwillingness to accept a blood transfusion.
• Inability or unwillingness to complete post- treatment surveillance for 60 days.
• Diagnosis of major comorbidities expected to interfere with subjects study participation for 60 days.

Inclusion criteria

• A diagnosis of idiopathic pulmonary fibrosis that fulfills American Thoracic Society Consensus Criteria.
• Unexplained worsening or development of dyspnea or hypoxemia within 30 days leading to the current hospitalization.
• Radiographic imaging showing ground-glass abnormality and/or consolidation superimposed on a background of reticular or honeycomb pattern consistent with usual interstitial pneumonia.
• Intent on the part of the treating physician to use high dose steroid therapy as a therapeutic effort to treat a diagnosis of acute IPF exacerbation.

Exclusion criteria

• Diagnosis of documented infection based upon clinical evaluation and microbial testing.
• Diagnosis of thromboembolic disease by clinical assessment.
• Diagnosis of an additional etiology for Acute Lung Injury/Acute Respiratory Distress Syndrome based upon clinical assessment to include sepsis, aspiration, trauma, inhalational injury, acute pancreatitis, drug toxicity, blood product transfusion reaction, or stem cell transplantation.
• Diagnosis of congestive heart failure that accounts for the hypoxemia.
• Presence of active hepatitis B infection.
• Coagulopathy defined as an International Normalized Ratio > 1.8, Partial Thromboplastin Time > 2 x control, and platelet count < 50,000.
• Hyperosmolar state or diabetic ketoacidosis to suggest uncontrolled diabetes mellitus or uncontrolled hypertension (systolic BP > 160 mm Hg and diastolic BP > 100 mm Hg) which would contraindicated the use of corticosteroids.
• Hemodynamic instability defined as a vasopressor requirement which would contraindicate the use of plasmapheresis.
• History of reaction to blood products, murine-derived products, or prior exposures to human-murine chimeric antibodies,
• History of malignancy.
• Inability or unwillingness to accept a blood transfusion.
• Inability or unwillingness to complete post- treatment surveillance for 60 days.
• Diagnosis of major comorbidities expected to interfere with subjects study participation for 60 days.