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IPF treatment guidelines updated

Thursday, 16 Jul 2015


Updated guidelines on the treatment of idiopathic pulmonary fibrosis have been published by an international group of respiratory societies.

The guidelines update evidence from 2011 and are published by the American Thoracic Society, the European Respiratory Society, the Japanese Respiratory Society, and the Latin American Thoracic Association in the American Journal of Respiratory and Critical Care Medicine.

Chair of the guidelines committee  Ganesh Raghu from the Center for Interstitial Lung Disease at the University of Washington Medical Center said the the updated guidelines did not recommend one treatment regimen over another.

All of these recommendations must be weighed individually, considering all the factors used to grade each one, including the confidence in effect estimates, evidence from outcomes studies, desirable and undesirable consequences of treatment, treatment costs, the implications of treatment on health equity, and the feasibility of treatment,” he said. 

The following recommendations are new or revised from the 2011 guidelines:

The recommendation against the use of the following agents for the treatment of IPF is strong:

    • Anticoagulation (warfarin)
    • Imatinib, a selective tyrosine kinase inhibitor against platelet-derived growth factor (PDGF) receptors
    • Combination prednisone, azathioprine, and N-acetylcysteine
    • Selective endothelin receptor antagonist (ambrisentan)

The recommendation for the use of the following agents for the treatment of IPF is conditional:

    • Nintedanib, a tyrosine kinase inhibitor that targets multiple tyrosine kinases, including vascular endothelial growth factor, fibroblast growth factor, and PDGF receptors
    • Pirfenidone

The recommendation against the use of the following agents for the treatment of IPF is conditional:

    • Phosphodiesterase-5 inhibitor (sildenafil)
    • Dual endothelin receptor antagonists (macitentan, bosentan)

Recommendations remaining unchanged from the 2011 guidelines include a conditional recommendation against the use of N-acetylcysteine monotherapy for IPF and a conditional recommendation for the use of antiacid therapy.

For a full copy of the guidelines click here.

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