A 60-year-old man is diagnosed with IPF (confirmed UIP on HRCT without BAL lymphocytosis or surgical biopsy needed). He has FVC 72% predicted. Which antifibrotic therapy is APPROVED and shown to slow FVC decline?
- A N-acetylcysteine monotherapy
- B Nintedanib or pirfenidone ✓
- C Azathioprine plus prednisolone
- D Sildenafil for pulmonary hypertension component
Correct answer: B. Nintedanib or pirfenidone
Explanation
Both nintedanib (INPULSIS trial) and pirfenidone (ASCEND/CAPACITY trials) are approved antifibrotic agents that reduce the annual FVC decline in IPF by approximately 50% compared to placebo. The PANTHER-IPF trial demonstrated that azathioprine plus prednisolone triple therapy was harmful in IPF. N-acetylcysteine monotherapy showed no benefit. Sildenafil addresses pulmonary hypertension but not the fibrotic process.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.