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The response to our article identifies the hazard of reviewing a topic in the middle of a paradigm shift, and was helpful in identifying pirfenidone and acetylcysteine as other potential agents for the management of idiopathic pulmonary fibrosis (IPF).1 Our review was aimed at identifying immunological mechanisms underlying the remodelling process and did not suggest optimal management, which is at present not clear. In fact, a recent BTS study of IPF management still highlighted the importance of anti-inflammatory therapy in achieving better clinical responses.2 Furthermore, uncertainty in the rapidly changing area of antifibrotic therapy has resulted in significant delays in producing guidelines to support clinicians.3 4 We look forward to confirmation of promising early clinical trails of pirfenidone and acetylcysteine5 6 and their translation into clinical practice. Our optimism is tempered by experience with “false Messiahs” noted by Maher and Wells in their letter.7
Competing interests: None.
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