Pirfenidone vs nintedanib for treatment of idiopathic pulmonary fibrosis in clinical practice: efficacy, tolerability, and adverse effects

Abstract

Background Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and fatal disease, with a median survival of ∼2–5 years. The main target of treatment was to stabilize or reduce the rate of disease progression. Nintedanib and pirfenidone are new drugs that could be considered a breakthrough in the management of IPF as anti-inflammatory and antifibrotic agents. Aim The aim was to evaluate the efficacy, tolerability, and adverse effects of pirfenidone and nintedanib in the management of IPF. Patients and methods A total of 50 patients (38 males and 12 females) were included in our study. IPF diagnosis was established according to the international guidelines. The patients were started on antifibrotic therapy with either pirfenidone or nintedanib. Clinical, functional, and radiological follow-ups were done for all patients prospectively at baseline, at 6 months, and at 12 months of therapy. Result The mean age of nintedanib group was significantly higher (78.41±6.8 vs 62.34±6.3 years for pirfenidone group; P<0.0001). Male sex was more prevalent (72% for pirfenidone group and 80% for nintedanib group). No significant differences in forced expiratory volume in the first second, forced vita capacity (FVC), forced expiratory volume in the first second/FVC, total lung capacity, and diffusion capacity of carbon monoxide % of predicted were found at baseline. At 6 months, High-resolution computed tomography showed significant regression of the disease in 33% of nintedanib group. At 12 months, there were significant improvements in FVC and diffusion capacity of carbon monoxide % predicted for nintedanib group. Skin rash, weight loss, and vomiting were the most frequent in pirfenidone group (28% for each), whereas 64% developed diarrhea in the nintedanib group. Drug discontinuation was significantly higher in the nintedanib group (24 vs 8% for pirfenidone group). Exacerbation on therapy was significantly higher in the pirfenidone group (36 vs 16% for nintedanib group). Conclusion Both pirfenidone and nintedanib appeared to stabilize a disease typically associated with progressive deterioration in the clinical, functional, and radiological parameters. Nintedanib had better clinical, functional, and radiological outcomes but also had lower tolerability and more serious AE than pirfenidone.

Keywords

• adverse events
• efficacy
• nintedanib
• pirfenidone
• pulmonary fibrosis
• tolerability