OBJECTIVES: Idiopathic pulmonary fibrosis (IPF) is a rare, progressive form of fibrosing interstitial pneumonia which results in loss of lung function and premature mortality. The FDA first approved treatments for IPF in late 2014. The aim of this systematic review and network meta-analysis (NMA) is to perform a mixed treatment comparison of the efficacy of available pharmacologic treatments for IPF.  METHODS: Medline, EMBASE, CENTRAL, and PROSPERO were searched for randomized clinical trials in patients with IPF and supplemented with hand searches.  Only randomized trials consisting exclusively of IPF patients were included. All studies were independently abstracted by two analysts. The primary outcome of interest was the standardized mean difference between treatment and control of change in percent predicted forced vital capacity (FVC) from baseline to one year.  RESULTS: Literature review identified 1,191 records of which 36 met our inclusion criteria. Fixed effects pairwise comparisons of the standardized mean difference (SMD) of intervention versus placebo suggested better performance of nintendanib relative to other treatments with a 4.9% (95%CI: 3.8-6.0) standardized improvement relative to placebo in %FVC . This falls comfortably within the range of minimal clinically important difference for this endpoint as measured by other authors. The data structure for pirfenidone did not allow for comparison of %FVC. Sildenafil, N-acetylcysteine (NAC), and azathioprine did not show statistically significant improvement relative to placebo. CONCLUSIONS: Nintenadib offers a new treatment option for a disease where few options existed. Based on studies reviewed, sildenafil and NAC treatments did not slow disease progression as measured by change in percent FVC and their use in IPF should be limited.