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IPF Antifibrotic Treatment — RACP Adult Medicine MCQ

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EasyRespiratoryIPF Antifibrotic TreatmentRACP Adult Medicine

A 65-year-old man with confirmed IPF (UIP pattern on HRCT) has progressive symptoms with FVC declining from 80% to 70% predicted over 12 months. He has no other comorbidities limiting life expectancy. He is being referred for lung transplant assessment. What is the most appropriate pharmacological treatment?

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Correct answer: C — Nintedanib or pirfenidone

Antifibrotic therapy (nintedanib or pirfenidone) is the standard treatment for IPF. Both slow FVC decline by ~50% per year (INPULSIS and ASCEND trials). Immunosuppression (prednisolone, azathioprine) is HARMFUL in IPF (PANTHER-IPF trial — increased mortality). Antifibrotics do not reverse fibrosis but slow progression. Lung transplant assessment should be considered early for eligible patients with progressive disease.

Reference: ATS/ERS/JRS/ALAT – 2022 – IPF Guidelines; eTG Respiratory 2024