Retrospective Analysis of Medication Utilization and Clinical Outcomes in Patients With Idiopathic Pulmonary Fibrosis Treated With Nintedanib or Pirfenidone

Abstract

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease which results in thickening and scarring of the interstitial tissue. As the only 2 Food and Drug Administration (FDA)-approved medications on the market, it is valuable to compare the impact of nintedanib and pirfenidone on clinical outcomes. Records of patients who started nintedanib or pirfenidone between calendar years 2015 and 2016 at a national specialty pharmacy were retrospectively reviewed. Data collection was derived from patient management applications and statistical data analysis was completed in SAS (SAS Institute Inc®). The nintedanib population contained 2605 patients and of the population completing clinical assessment surveys (n = 1343), 46% of respondents (n = 612) reported no adverse events, with the remaining 54% reporting at least 1 adverse event. Average proportion of days covered (PDC) was 84.2% (SD = 17.0). Average final monthly copay for this group was $235. The pirfenidone population had 1322 patients, and of the surveyed population (n = 764), 58% of respondents (n = 445) reported no adverse events, with the remaining 42% reporting at least 1 adverse event. Average PDC was 83.4% (SD = 17.3). Average final monthly copay for this group was $339. Outcomes in the studied IPF population were similar for nintedanib and pirfenidone.

Effects of Oral Zafirlukast, Sildenafil, or Pirfenidone on the Formation of Postsurgical Intra-Abdominal Adhesions in an Experimental Rat Model

“…Although sildenafil and pirfenidone did not completely prevent intra-abdominal adhesions, there were statistically significant differences in terms of the quality of adhesions. This finding differs significantly from that observed in cutaneous and parenchymal soft tissues in other organs, such as the lung [35].…”

“…By having several targets of action, although some are completely inhibited, the functions of others are diminished, and pirfenidone’s antifibrotic capacity is amplified [34]. Note that this drug acts at the pretranscription level, giving it a more significant advantage by directly preventing the formation of profibrotic products and proteins, such as collagen, which contributes to postoperative adhesions [35]. In addition, pirfenidone reduced adhesion formation and applied the antifibrotic effects through the reduction of T helper 2 and Treg cells in rats [36].…”

Real-World Study Analysing Progression and Survival of Patients with Idiopathic Pulmonary Fibrosis with Preserved Lung Function on Antifibrotic Treatment

“…Currently, there are two licensed medications for IPF which are effective in reducing the progression of lung fibrosis over time. These are pirfenidone and nintedanib; both of these drugs decelerate lung fibrosis in patients with mild to moderate disease [5]. Whilst existing landmark clinical trials have demonstrated the efficacy of these two agents in cohorts with moderate forced vital capacity (FVC) impairment [6][7][8], post hoc studies have in fact demonstrated favourable outcomes of the drugs even in groups with a higher baseline lung function (i.e.…”

Adherence, Persistence, and Effectiveness in Real Life. Multicenter Long-Term Study on the Use of Pirfenidone and Nintedanib in the Treatment of Idiopathic Pulmonary Fibrosis

“…The analysis we carried out over two years shows that, despite the dosage regimen, adherence to treatment is good for both drugs and remained high throughout the observation period, never falling below the 80% threshold level. The adherence values described in this study demonstrate how for IPF the need for treatment, management by health professionals and inclusion 51 Treatment persistence values showed an average loss of 30% in the first year and 50% in the second year. This datum includes patients who discontinue treatment for any cause, with a value 25% lower than data published by Margaritopoulos et al, which described an overall survival of 75% at year 2 for pirfenidone alone.…”

“…These data were in line with what has already been described in the only work published so far by Ipatova et al on pharmacoutilization, although such data only harvested results from a 6-month analysis. 51 Treatment persistence values showed an average loss of 30% in the first year and 50% in the second year. This datum includes patients who discontinue treatment for any cause, with a value 25% lower than data published by Margaritopoulos et al, which described an overall survival of 75% at year 2 for pirfenidone alone.…”