P159 Longitudinal follow-up data on cotrimoxazole treatment for idiopathic pulmonary fibrosis and fibrotic non-specific interstitial pneumonia

49 patients with UIP/IPF or fibrotic NSIP have so far been randomised between October 2012-July 2018 to 12 weeks of oral cotrimoxazole or placebo with folic acid supplement, following which all receive active treatment (cotrimoxazole 960 mg BD) and long-term follow-up. In the first year arterial gases and formal lung function are measured at start, 3, 6 and 12 months along with 4 quality of life measures and CT scans at start and 12 months and scored according to Hansel and Wells. Out of study spirometry, oxygen saturations and Shuttle walk test (SWT) have continued long-term and the data is presented in the table with the relative change from the individuals own baseline (BL) calculated for each patient in brackets. 84% were UIP and 16% fibrotic NSIP. Mean age 74 year (range 56–86).

Results

The yearly data for each subject, with some data out to year 6 is presented.

Conclusion

The FVC remained stable on treatment in the first 5 years. SWT increased significantly at 24 and 52 weeks and generally remained stable with time. The MRC-5point score improved on treatment. Total lung capacity (TLC) improved significantly at 1 year by +19% along with residual volume by +42%. TLCO showed no consistent change. 1 fatal exacerbation occurred at week 6 during the DBRPC period. Out of 23 deaths, 56% were cancer or cardiac events. Most respiratory deaths followed bacterial pneumonia or a slowly progressive picture of IPF with pulmonary hypertension. IPF is associated with a progressive decline in lung function. This data shows improved residual volume and total lung capacity at 1 year, with largely stable FVC, oxygen saturations and SWT in year 2–5 suggesting that cotrimoxazole may help to slow the rate of decline in lung function.