Treatment based on changes in the bacterial load in the lungs in IPF

Some recently published papers reported changes in the bacterial load in the lungs of patients with idiopathic pulmonary fibrosis. Are there any ongoing trials on antibiotics or other treatments based on these findings?

Luca Richeldi: This is a very exciting field because it is new. It is the study of so-called microbiome applied to idiopathic pulmonary fibrosis. There are data from the UK showing that the type of microbiome is able to predict the disease course, and also that differences in the microbiome are linked or associated with the rate of acute exacerbations. So there is some basic science supporting the idea of using antibiotics in these patients.

There has been already one phase 2 clinical trial of cotrimoxazole providing evidence that maybe in the intention-to-treat population, patients compliant with the dose of cotrimoxazole may have a benefit in survival. In the UK, there is now a large phase 3 trial enrolling patients against placebo or antifibrotic therapy, randomized to high-dose cotrimoxazole or placebo.

So I hope that in a few months if not years we will have an answer to that question, but for the time being it seems like a promising idea to develop in the context of a clinical trial.