Predicting outcomes and monitoring longitudinal treatment response in IPF is unreliable using currently available clinical biomarkers. We investigate associations between hyperpolarized 129Xe MRI biomarkers of ventilation and gas exchange and treatment with anti-fibrotic medication in IPF patients over a 1-year period. Anti-fibrotic treatment was associated with improved ventilation and gas exchange, relative to no anti-fibrotic treatment, after 1 year. Within-patient improvements in gas exchange were significantly larger in patients treated with anti-fibrotic medications. No longitudinal associations were found between anti-fibrotic treatment and spirometry, suggesting the imaging biomarkers may be more useful for monitoring anti-fibrotic treatment response in IPF.