A 45-year-old woman is diagnosed with idiopathic pulmonary fibrosis (IPF) confirmed on HRCT (UIP pattern). FVC is 72% predicted. She has no contraindications to antifibrotic therapy. Which of the following is the most appropriate disease-modifying treatment?

• A Prednisolone 40 mg/day as first-line therapy
• B N-acetylcysteine triple therapy (NAC + azathioprine + prednisolone)
• C Nintedanib is preferred over pirfenidone due to superior survival benefit
• D Nintedanib or pirfenidone — both have equivalent evidence for slowing FVC decline ✓

Explanation

Nintedanib (INPULSIS trials) and pirfenidone (CAPACITY, ASCEND trials) are both approved for IPF and have shown equivalent efficacy in slowing the annual rate of FVC decline by approximately 50% compared with placebo. Neither has demonstrated a definitive survival benefit over the other, and choice is guided by tolerability and comorbidities. High-dose corticosteroids are harmful in IPF. The ACE (PANTHER) trial showed that NAC + azathioprine + prednisolone increased mortality and hospitalisation versus placebo, and triple therapy is contraindicated in IPF.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.