The American Thoracic Society recently published updated guidelines for IPF. These new guidelines reflect the recent advances in treatment. We provide the link for those interested in the unabridged document. Below I summarize the recommendations.
New and Revised Recommendations Against Use
1. Anticoagulation: strong recommendation against use for treatment of IPF
2. Prednisone+Azathioprine+N-acetytceteine: strong recommendation against use
3. Endothelin Receptor Antagonists (Bosentan, Letairis, Opsumit): recommendation against use
4. Phospodiesterase -5 Inhibitors: conditional recommendation against use for IPF (there may be a role in patients with concurrent pulmonary hypertension- this was not addressed by the document)
5. Imatinib- strong recommendation against use
New and Revised Recommendations For Use
1. Esbriet (Pirfenidone)- conditional recommendation for use
2. OFEV (Nintedanib)- conditional recommendation for use
Unchanged Recommendations For Use
1. Anti-acid therapy- conditional recommendation for use
2. Lung transplantation- continues to be recommended for eligible patients. No position on single versus bilateral lung transplantation
Unchanged Recommendation Against Use
1. N-acetylcysteine monotherapy: conditional recommendation against use
Recommendations regarding treatment of pulmonary hypertension in the context of IPF were not made.