Tolerability and efficacy of second-line antifibrotics in patients with idiopathic pulmonary fibrosis

Çilli, Aykut; Üzer, Fatih; Sevinç, Can; Çoşkun, Funda; Ursavaş, Ahmet; Öner, Şükriye; Köse, Fırat

doi:10.1016/j.pupt.2021.102099

Cited by 4 publications

(6 citation statements)

References 12 publications

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“…Because PFD and NT have different mechanisms of action and pharmacological profiles, switching anti-fibrotic drugs can be required in clinical practice in cases of drug intolerance or disease progression despite of anti-fibrotic treatment. Several studies have reported on the tolerability and efficacy of second-line NT treatment for patients with IPF who have discontinued PFD treatment [ 12 – 15 ]; however, to the best of our knowledge, there are only a few reports on second-line PFD [ 16 , 17 ]. The change from PFD to NT has been reported in 10.5%—14.1% of patients [ 15 – 17 ]; however, in the present study, 53 of 170 patients (31.1%) were switched from NT to PFD because of unacceptable adverse effects (n = 25) and disease progression (n = 28).…”

Section: Discussionmentioning

confidence: 99%

Tolerability and efficacy of switching anti-fibrotic treatment from nintedanib to pirfenidone for idiopathic pulmonary fibrosis

Sugino,

Ono,

Saito

et al. 2024

PLoS ONE

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Background In real-world studies, the rate of discontinuation of nintedanib (NT) varies from 4% to 53%. Switching anti-fibrotic treatment in patients with idiopathic pulmonary fibrosis (IPF) has not been adequately investigated, and data on the tolerability and efficacy of changes in anti-fibrotic treatment is limited in clinical practice. Objective To identify factors associated with poor continuation of NT, efficacy and predictors of deterioration after switching from NT to pirfenidone (PFD) in patients with IPF. Subjects and methods One hundred and seventy patients with IPF in whom NT was introduced between April 2017 and March 2022 were included to investigate NT continuation status and the effect of switching to PFD. Results A total of 123 patients (72.4%) continued NT for 1 year and had a significantly higher %forced vital capacity (FVC) at NT introduction than those who discontinued within 1 year (80.9% ± 16.3% vs. 71.9% ± 22.1%, P = 0.004). The determinant of poor NT continuation was the high GAP stage. On the other hand, 28 of 36 patients who discontinued NT because of disease progression switched to PFD. Consequently, FVC decline was suppressed before and after the change. The predictor of deterioration after the switch was a lower body mass index. Conclusions In patients with IPF, early NT introduction increased continuation rates, and switching to PFD was effective when patients deteriorated despite initial NT treatment.

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Section: Discussionmentioning

confidence: 99%

Tolerability and efficacy of switching anti-fibrotic treatment from nintedanib to pirfenidone for idiopathic pulmonary fibrosis

Sugino,

Ono,

Saito

et al. 2024

PLoS ONE

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“…In addition, AFT efficacy does not seem to disappear after an event of progression; therefore, continuity seems to be a reasonable option (and preferred over discontinuation alone). 49 - 51 …”

Section: Treatmentmentioning

confidence: 99%

Idiopathic pulmonary fibrosis: current diagnosis and treatment

Colares

Kairalla

2023

J Bras Pneumol.

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Idiopathic pulmonary fibrosis (IPF) is a devastating chronic lung disease without a clear recognizable cause. IPF has been at the forefront of new diagnostic algorithms and treatment developments that led to a shift in patients' care in the past decade, indeed influencing the management of fibrotic interstitial lung diseases other than IPF itself. Clinical presentation, pathophysiology, and diagnostic criteria are briefly addressed in this review article. Additionally, evidence regarding the use of antifibrotics beyond the settings of clinical trials, impact of comorbidities, and therapeutic approaches other than pharmacological treatments are discussed in further detail.

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“…Because PFD and NT have different mechanisms of action and pharmacological profiles, switching anti-fibrotic drugs can be required in clinical practice in cases of drug intolerance or disease progression despite of anti-fibrotic treatment. Several studies have reported on the tolerability and efficacy of second-line NT treatment for patients with IPF who have discontinued PFD treatment [12][13][14][15]; however, to the best of our knowledge, there are only a few reports on second-line PFD [16,17]. The change from PFD to NT has been reported in 10.5%-14.1% of patients [15][16][17]; however, in the present study, 53 of 170 patients (31.1%) were switched from NT to PFD because of unacceptable adverse effects (n = 25) and disease progression (n = 28).…”

Section: Plos Onementioning

confidence: 99%

“…Several studies have reported on the tolerability and efficacy of second-line NT treatment for patients with IPF who have discontinued PFD treatment [12][13][14][15]; however, to the best of our knowledge, there are only a few reports on second-line PFD [16,17]. The change from PFD to NT has been reported in 10.5%-14.1% of patients [15][16][17]; however, in the present study, 53 of 170 patients (31.1%) were switched from NT to PFD because of unacceptable adverse effects (n = 25) and disease progression (n = 28). Three of 25 patients who were switched to PFD because of NT's adverse effects and one out of 28 patients who was switched to PFD because of disease progression discontinued treatment because of PFD's adverse effects.…”

Section: Plos Onementioning

confidence: 99%

“…Because PFD and NT are characterised by different mechanisms of action and pharmacological profiles, switching anti-fibrotic drugs can be required in clinical practice when drug intolerance or disease progression despite of anti-fibrotic treatment is recognised. A few studies with small sample sizes demonstrated that second-line NT treatment could be effective for patients with IPF who have discontinued PFD treatment [12][13][14][15][16][17]. However, some patients with IPF who were switched from PFD to NT showed rapid disease progression or early termination despite treatment [12,13].…”

Tolerability and efficacy of second-line antifibrotics in patients with idiopathic pulmonary fibrosis

Cited by 4 publications

References 12 publications

Tolerability and efficacy of switching anti-fibrotic treatment from nintedanib to pirfenidone for idiopathic pulmonary fibrosis

Tolerability and efficacy of switching anti-fibrotic treatment from nintedanib to pirfenidone for idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis: current diagnosis and treatment

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