Updated Guidelines Released for Treatment of Idiopathic Pulmonary Fibrosis

The American Thoracic Society recently joined with the European Respiratory Society, the Japanese Respiratory Society, and the Latin American Thoracic Association to update treatment guidelines for idiopathic pulmonary fibrosis. The updated guidelines are published in the American Journal of Respiratory and Critical Care Medicine.

“The updated guidelines do not recommend one treatment regimen over another,” said Ganesh Raghu, MD, professor of medicine, University of Washington, who chaired the guideline committee. “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.”

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Committee members reviewed existing evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach and rated treatment recommendations as either “strong” or “conditional.”

The updated guidelines differ from 2011 guidelines in their strong recommendations against using combination azathioprine, N-acetylcysteine and prednisoneand; anticoagulation; imatinib; and ambrisentan. Also new in the updated guidelines are conditional, or weak, recommendations against the use of bosentan, macitentan, and sildenafil. The new guidelines provide conditional recommendations for the use of nintedanib and pirfenidone.

Meanwhile, a conditional recommendation against the use of N-acetylcysteine monotherapy and 1 for the use of antacid therapy remain unchanged since the 2011 guidelines.

“Our systematic review of the available evidence on idiopathic pulmonary fibrosis treatments points to the need for additional research and long-term studies of their safety and efficacy,” said Dr Raghu. “This is especially true for treatments that received conditional recommendations in the guidelines.”—Jolynn Tumolo

References

1. Raghu G, Rochwerg B, Zhang Y, et al. An official ATS/ERS/JRS/ALAT clinical practice guideline: treatment of idiopathic pulmonary fibrosis. An update of the 2011 clinical practice guideline. American Journal of Respiratory and Critical Care Medicine. 2015;192:e3-e19.
2. New guidelines for the treatment of idiopathic pulmonary fibrosis released by leading respiratory societies [press release]. Newswise: Charlottesville, VA; July 13, 2015.