according to this invention there is provided a use of doxycycline , a non - specific matrix - metalloproteinase inhibitor , for treatment of idiopathic pulmonary fibrosis , and the dose for the adult is 100 mg every 12 hours during the first 24 hours followed by 100 mg once or twice a day depending on the body weight of the patient . ipf patients respond very well to matrix metalloproteinase inhibitor doxycycline , because of its ability to interfere with matrix metalloproteinase ( mmp ) activity . incidentally doxycycline has long been in use in clinical medicine without much side effects and long term use of doxycycline is also documented well in some conditions . recently , there has been a report of successful treatment of pulmonary capillary hemangiomatosis with atypical endotheliomatosis refractory to steroid and alpha interferon by using doxycycline for over 18 months . in fact , tetracycline , doxycycline , and chemically modified tetracycline all can decrease mmp production and activity . doxycycline is the only mmp inhibitor reportedly approved by the fda for periodontal disease . doxycycline is a commonly used antibiotic . the adult dose is 100 mg every 12 hours during the first 24 hours followed by 100 mg once a day or twice daily according to the severity of the infection being present and the doctors &# 39 ; discretion . in situations where long term treatment is necessary , the dose mostly used is 100 mg twice daily . the dose used for treating a non infective condition named pulmonary capillary hemangiomatosis with atypical endotheliomatosis on a long term was also the same as 100 mg twice daily . the patient who received long term doxycycline for the treatment of probable ipf by us was also treated with the dose of 100 mg twice a day . the same dose has been used in another case series where a follow up result after a mean duration of 306 days is analyzed . in all the examples the drug has been well tolerated . hence , we propose the dose of 100 mg twice daily for adults of average weight for treatment of ipf on a long term basis . however , the final and the best dose can only be determined after using the drug in different dosages in a proper clinical trial . the proposed mechanism of doxycycline for treatment of idiopathic pulmonary fibrosis ( ipf ) has been totally different from that applicable for its antimicrobial effect . doxycycline is a non specific matrix metallo - proteinase ( mmps ) inhibitor . mmps are a class of zinc endopeptidase and they play an important part in modulation of fibrogenesis following epithelial injuries in cases of ipf . an imbalance with its tissue inhibitor in favour of mmps leads to release of several growth factors including insulin - like growth factors ( igfs ), transforming growth factors - β ( tgf - β 1 ) and tumor necrosis factor α ( tnf - α ). they / these substances are known to enhance fibrosis . indeed , a synthetic inhibitor of mmp , batimastat has been shown to significantly reduce bleomycin induced lung fibrosis ( in rats ) that points to the importance of mmps in the development of the fibrotic disease of the lungs . since doxycycline has been available in the market over 30 years without much side effects and with experience of long term use and its mmps inhibition is well known , the drug imparts a favorable effect on the patients of ipf the drug is administered orally preferably after 30 minutes to one hour of food to prevent disturbance in absorption . the duration of treatment with doxycycline depends on the indication concerned and it can be varying from a few days to a few years . for most infections , doxycycline is taken once or twice daily for 7 to 14 days . infection with mycoplasma pneumonae is treated for a duration of 10 - 14 days . doxycycline has been recommended for use as a first line drug for brucellosis with streptomycin or rifampicin for 6 weeks . field trials in 2005 showed that doxycycline almost completely eliminates blood - borne filaria when given for an 8 week course . periodontal disease is a condition where doxycycline has been recommended for longer duration . in clinical studies , doxycycline hyclate ( periostat ) was shown to be safe when taken for as long as 12 months and typically , the drug is taken for periods of no less than 3 months for periodontal disease . prolonged therapy with doxy has been recorded well in toleration for over months . doxycycline can be used as a substitute in penicillin allergic patients . in q fever endocarditis doxycycline was given for a mean duration of 55 months ( median 60 months ) in combination with ofloxacin and for a mean duration of 31 months ( median 26 months ) with hydroxychloroquine where the patients treated were declared cured . similar experience of q - fever endocarditis has been described in a patient with biological prosthetic aortic valve and aortic homograft ; the patient was successfully treated with doxycycline and chloroquine for 2 years . doxycycline is licensed for up to two years or more in the treatment of acne in the same dose as is used for malaria prevention . the acmp ( advisory committee for malaria prevention of uk ) have concluded that there is no evidence of harm in long - term use of doxycycline and it may be taken safely for periods of at least up to two years . a case of pulmonary capillary hemangiomatosis with atypical endotheliomatosis was treated for 2 yrs without any problem . recently , doxycycline has been reported to have a biological function apart from its antimicrobial function . doxycycline is known to inhibit the release of reactive oxygen species , while also inducing apoptosis , decreasing neutrophil chemotaxis and inhibiting matrix metalloproteinases . one patient of suspected ipf has been treated by us for over seven months with 100 mg twice daily dose of doxycycline with no intolerance or adverse reaction . also in a small case series prepared by us and ready for publication , it has been shown that the use of doxycycline for a mean period of 306 days in cases of suspected ipf patients was well tolerated . hence , we wish to recommend a dose of 100 mg bid ( twice daily ) for usual adult patients of ipf . however , trials with different dosages are needed to be conducted for finding out the best suitable dose of mmps inhibition for ipf patients . the invention will now be explained in details with the help of following test results and illustrate in the accompanying drawings . patient now in doxycycline ( 100 mg twice a day ) for over six months hrct suggestive of idiopathic pulmonary fibrosis and the bronchioalveolar lavage did not suggest any alternative diagnosis patient is presently on doxycycline ( 100 mg twice a day ) for over 3 months patient has been on doxycycline ( 100 mg twice a day ) for over 10 months patient was evaluated after receiving doxycycline ( 100 mg twice a day ) for over 7 months c ) dlco ( diffusion capacity ) and fev1 ( forced expiratory volume in the first one second ): results enclosed below treatment with doxycycline + azathioprine ( azoran ), a drug presently used for treatment of idiopathic pulmonary fibrosis ( ipf ) the patient has been receiving doxycycline ( 100 mg twice a day )+ azoran ( 1 mg per kg of body weight ) for over 24 months
use of doxycycline , a non specific matrix metalloproteinase inhibitor , for treatment of idiopathic pulmonary fibrosis and a pharmaceutical composition comprising doxycycline or its congener in combination with another compound selected from the drug listed for treatment of idiopathic pulmonary fibrosis in a standard dose .