Co-trimoxazole for idiopathic pulmonary fibrosis: time for TIPAC-2?
- Centre for Translational Inflammation and Fibrosis Research, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
- Correspondence to Dr David R Thickett, Centre for Translational Inflammation and Fibrosis Research, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK;
Idiopathic pulmonary fibrosis (IPF) is a devastating disease with an average life expectancy from diagnosis of 2.5 years with 5 year survival of between 20% and 40%. Currently there are no therapies proven to reduce mortality and only one drug, pirfenidone, is licensed for use in Europe that may slow the progression of the disease. Cleary developing effective therapy for IPF is a major unmet health need.
Shulgina et al present the results of TIPAC- a randomised placebo controlled trial of co-trimoxazole in patients with fibrotic interstitial lung disease.1 This was a National Institute for Health Research, Research for Patient Benefit funded trial, and is to our knowledge the largest investigator led, non-commercially funded placebo controlled drug trial in IPF ever to have been undertaken in the UK.
The headline results of this paper are that co-trimoxazole treatment has no effect on pulmonary function or 6 min walk distance in patients with fibrotic idiopathic interstitial pneumonia (the vast majority of whom had IPF) but given adequate adherence to the medication may lead to a significant reduction in all-cause mortality associated with reduction in frequency of respiratory tract infections and improved overall health-related quality of life.1
The background to the use of co-trimoxazole in IPF started with work from Varney et al.2 In 1996, Dr Varney noticed clinical improvement in a patient with oral co-trimoxazole. Subsequently, 14 patients with end stage fibrotic lung disease also responded clinically to oral co-trimoxazole. This prompted a double blind randomised …