PPI use hard to justify in IPF


By Mardi Chapman

8 May 2019

Contrary to current clinical guidelines, new evidence suggests there is no value in the routine use of antacids in patients with idiopathic pulmonary fibrosis (IPF).

Instead, the findings suggest reflux directed therapy should be considered on an individual basis.

A study of 587 patients from the Australian IPF registry showed no clinical benefit from proton pump inhibitors (PPIs) or histamine-2 receptor antagonists after a median follow-up of 2.2 years.

At baseline, 65% of patients were taking antacid therapy, predominately PPIs (90%).

Of those patients receiving antacid treatment, only 50% reported significant symptoms and only 41.4% reported a diagnosis of GORD.

However the study found there was no difference in disease progression (annual fall in FVC% predicted) or mortality between those patients taking antacids and those patients who weren’t.

“In this analysis of real-world IPF patients from the Australian IPF Registry, treatment with antacid therapy did not have any impact on either IPF disease progression or survival, regardless of the presence of reflux symptoms,” the study said.

“There was also no association between either the presence of typical reflux symptoms nor symptom severity with IPF disease progression or survival.”

“In the absence of prospective, randomised controlled trials showing benefit of antacid medications in IPF, this study suggests that antacid therapy should not be recommended broadly for the treatment of IPF patients.”

They said that given the conditional recommendation for antacid therapy in the current IPF guidelines, there was a need for further prospective randomised controlled trials.

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