Key messages
- •
Because multiple coactivated pathways are involved in the pathogenesis of idiopathic pulmonary fibrosis, targeted therapies are unlikely to work well in isolation
- •
An evolution from monotherapy to combination therapy has been the rule in other respiratory diseases
- •
In interstitial lung diseases other than idiopathic pulmonary fibrosis, combination therapy is attractive in principle, both to deal with diagnostic uncertainty and to suppress both pro-inflammatory and profibrotic pathways
- •
The recent successful treatment trials in idiopathic pulmonary fibrosis have created difficulties in quantification of future smaller incremental reductions in decline in forced vital capacity, the current preferred primary endpoint
- •
Personalised medicine and the combination therapy ethos are not mutually exclusive, but personalised medicine should not be assumed to hold the key to major future treatment advances in idiopathic pulmonary fibrosis