IPF treatments available in the UK now

Two antifibrotic medicines have been available on the NHS for IPF for around a decade, and a third was licensed in July 2026 but is not yet NHS funded. Alongside them sit oxygen, pulmonary rehabilitation, treatment for cough, palliative care and, for a small number of people, lung transplant.

Rentosertib is not among them.

The two antifibrotic medicines

Pirfenidone and nintedanib both slow the rate at which lung function declines. Neither stops IPF, and neither reverses the scarring that has already happened. NICE restated this plainly in 2026. In trials their effect is broadly similar, so the choice usually comes down to which side effects a person can live with.

Both are judged against forced vital capacity (FVC), a measure of how much air you can breathe out in one big breath. It is usually given as a percentage of what would be expected for someone of your age, height, sex and ethnicity.

Pirfenidone

NICE recommended pirfenidone in TA504 (February 2018) for people whose FVC is between 50% and 80% of predicted. The guidance includes a rule to stop treatment if FVC falls by 10% or more in absolute terms over 12 months. NICE has a live notice on TA504 saying it plans to review the FVC criteria, which many UK clinicians regard as an outlier internationally.

The usual dose is 801 mg three times a day, taken with food.

Common problems: nausea affects about 1 in 3 people (roughly 36%), and rash or sensitivity to sunlight affects up to about 1 in 5 (12% to 23%). Tiredness and loss of appetite are also common. People taking it are advised to use SPF 50 sunscreen all year round. Smoking reduces how well it works. Grapefruit should be avoided, and omeprazole and rifampicin interact with it. Regular liver blood tests are needed.

Several generic versions are now available.

Nintedanib

NICE recommended nintedanib in TA379 (January 2016) for FVC between 50% and 80% predicted, with the same 10% stopping rule. TA864 (February 2023) extended this to people whose FVC is above 80%, and that recommendation has no stopping rule. TA747 (November 2021) covers progressive fibrosing interstitial lung diseases other than IPF, regardless of FVC.

The usual dose is 150 mg twice a day, about 12 hours apart, with food. It can be reduced to 100 mg twice a day.

Common problems: diarrhoea affects about 2 in 3 people (roughly 63%). Nausea, vomiting, appetite loss and abdominal pain are also common. Less often it affects the liver or causes bleeding, and it interacts with blood-thinning medicines. Regular liver blood tests are needed.

Generic nintedanib became available in 2026, and NHS England confirmed confidential prices in May 2026. NICE has ruled that these lower prices must be used when assessing the value of any new IPF medicine, which changes the economics for everything in the pipeline.

The 10% stopping rule

Although the rule appears in the NICE guidance, clinical experts told NICE in 2026 that it is not routinely applied in NHS practice. Their argument was that a 10% fall predicts a worse outlook rather than showing that the treatment has failed. The NICE committee accepted that the rule “did not reflect current NHS clinical practice”.

Scotland is different

The Scottish Medicines Consortium accepted pirfenidone (advice 835/13) and nintedanib (1076/15) for FVC of 80% or below, with no lower limit. Nintedanib above 80% was accepted through SMC2513 in March 2023. So a person in Scotland whose FVC has fallen below 50% may still be eligible when someone in England would not be. The “50% to 80%” rule does not apply across the whole UK.

In Wales, NICE technology appraisals apply. In Northern Ireland the Department of Health endorsed TA864 in February 2023.

Where they can be started

In England, antifibrotics can only be started at an NHS England commissioned specialist ILD centre, of which there are around 23 to 24. Continuing prescriptions can often move closer to home under shared care. Scotland, Wales and Northern Ireland have no centre restriction: in Northern Ireland any respiratory physician can prescribe, and in Scotland prescribing is through secondary care, ideally after a multidisciplinary team discussion. See specialist ILD centres in the UK.

Nerandomilast: licensed, not yet funded

The MHRA licensed nerandomilast (brand name Jascayd) on 8 July 2026, the first approval in Europe. It is a tablet taken twice a day and works differently from the two antifibrotics.

It is not currently funded by the NHS. NICE published draft guidance on 19 August 2026 saying it should not be used, and final guidance is expected on 20 January 2027. The reasons are set out in how a new medicine reaches NHS patients.

Two practical differences: it does not require routine liver blood test monitoring, and in its trials diarrhoea affected about 4 in 10 people (41.3%) but was mostly mild and confined to the first three months.

Oxygen

NICE says oxygen needs should be assessed at every follow-up appointment and before discharge from hospital. Asthma + Lung UK suggests a referral if your oxygen level at rest is 92% or below, or if it drops when you move about. People with ILD often need ambulatory oxygen earlier, and at higher flow rates, than people with COPD. In the UK ILD Registry, 90% of people were assessed and 16% were using oxygen.

Pulmonary rehabilitation

This is a supervised programme of exercise and education, typically twice a week for six to eight weeks. NICE says it should be offered at diagnosis and reconsidered every 6 to 12 months. The British Thoracic Society published a new quality standard on 15 July 2026, including enrolment within 30 days of referral.

Referral rates have been poor. The UK ILD Registry recorded 57% referred, and an England-wide study covering 2010 to 2019 found only 12.0% were offered it and fewer than 2% completed it.

Cough

There is no licensed treatment for the cough of IPF, which many people find the most distressing symptom. NICE suggests treating reflux or post-nasal drip if present, and opioids may help. Thalidomide is sometimes used off-label through an ILD specialist. Physiotherapy and speech and language therapy can teach cough suppression techniques.

Breathlessness and palliative care

NICE recommends benzodiazepines or opioids for distressing breathlessness, and referral to palliative care. Palliative care is not only for the last weeks of life: it is symptom and support care that can run alongside treatment for years. Registry data suggest it is under-used, with 82% of people assessed but only 9% referred to non-specialist palliative care and 3% to specialist services.

Lung transplant

NICE says transplant should be discussed 3 to 6 months after diagnosis, and a transplant centre should respond within four weeks of referral.

There are six UK lung transplant centres: Royal Papworth, Wythenshawe in Manchester, the Freeman in Newcastle (which also serves Scotland), Harefield, Queen Elizabeth Hospital Birmingham, and Great Ormond Street for children.

Fibrosing lung disease accounts for 59% of adult registrations on the lung transplant list. In 2024/25 there were 146 adult lung transplants and 185 people waiting at the end of March 2025. The median wait was 449 days for non-urgent listing and 19 days for urgent listing, with wide variation between centres.

NHS Blood and Transplant’s listing policy requires that you are already on maximal treatment and have a projected survival after surgery of more than five years, plus at least one marker of decline, such as a 10% or greater fall in FVC over six months, a gas transfer measurement below 40% and falling, or oxygen saturation below 88% during a six-minute walk test. A body mass index above 35, cancer within the last five years, and smoking within the last six months are absolute barriers. The policy states that “age per se is not a contraindication”, though people over 60 are evaluated carefully. You can ask for a second opinion from a different centre.

Treatments NICE says should not be used

NICE CG163 advises against using these to try to change the course of IPF: ambrisentan, azathioprine, bosentan, co-trimoxazole, mycophenolate mofetil, prednisolone, sildenafil and warfarin. The evidence for N-acetylcysteine is described as uncertain. Some of these are still used for other reasons, such as treating a separate condition.

Where to read more

The NHS page on idiopathic pulmonary fibrosis was reviewed in August 2026. Asthma + Lung UK’s pulmonary fibrosis pages go into more detail on day-to-day management, though several of them carry a notice saying they are under review.