Safety and efficacy of bridging to lung transplantation with antifibrotic drugs in idiopathic pulmonary fibrosis: a case series

Delanote, Isabelle; Wuyts, Wim; Yserbyt, Jonas; Verbeken, Eric; Verleden, Geert M.; Vos, Robin

doi:10.1186/s12890-016-0308-z

Cited by 60 publications

(48 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Following lung transplant, pirfenidone was administered successfully in a woman who experienced progressive allograft dysfunction [47]. In another single-centre, retrospective analysis at a large-volume transplant centre, seven patients receiving pirfenidone underwent lung transplant with no serious post-operative AEs observed and no major drug interactions with other perioperative medications [44]. These experiences suggest that pirfenidone can be safely administered before lung transplant with good long-term outcomes.…”

Section: Ae Management In Specific Patient Subgroupsmentioning

confidence: 78%

See 1 more Smart Citation

Pirfenidone safety and adverse event management in idiopathic pulmonary fibrosis

et al. 2017

View full text Add to dashboard Cite

Pirfenidone is one of two approved therapies for the treatment of idiopathic pulmonary fibrosis (IPF). Randomised controlled clinical trials and subsequent post hoc analyses have demonstrated that pirfenidone reduces lung function decline, decreases mortality and improves progression-free survival. Long-term extension trials, registries and real-world studies have also shown similar treatment effects with pirfenidone. However, for patients with IPF to obtain the maximum benefits of pirfenidone treatment, the potential adverse events (AEs) associated with pirfenidone need to be managed. This review highlights the well-known and established safety profile of pirfenidone based on randomised controlled clinical trials and real-world data. Key strategies for preventing and managing the most common pirfenidone-related AEs are described, with the goal of maximising adherence to pirfenidone with minimal AEs.

show abstract

Section: Ae Management In Specific Patient Subgroupsmentioning

confidence: 78%

“…Currently there are no established guidelines regarding pirfenidone therapy in perioperative lung transplant [44]. Several case studies of pirfenidone use have been reported.…”

Section: Ae Management In Specific Patient Subgroupsmentioning

confidence: 99%

Pirfenidone safety and adverse event management in idiopathic pulmonary fibrosis

et al. 2017

View full text Add to dashboard Cite

show abstract

“…A pre-clinical lung transplantation study in rats revealed no evidence of impaired wound healing despite nintedanib being administered before and after the surgical procedure [44] and a small case study in Belgium (nintedanib, n = 2) showed no problems with bleeding or delayed wound healing related to anti-fibrotic treatment. There were some mild complications with anastomosis between the transplanted organ and the trachea in some patients; however, these were mild or uneventful [45]. A second retrospective study in Italy (nintedanib, n = 9), inclusive of data from 3 different transplant centers, also reported no problems with postoperative bleeding or thoracic wound healing [46].…”

Section: Expert Statements and Recommendationsmentioning

confidence: 99%

Nintedanib in Idiopathic Pulmonary Fibrosis: Practical Management Recommendations for Potential Adverse Events

et al. 2018

View full text Add to dashboard Cite

Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease with a dismal survival rate of only 3 years and no curative pharmacological therapy. The recent approval of 2 anti-fibrotic drugs (nintedanib and pirfenidone) that slow disease progression has provided some hope for patients. However, effectively managing anti-fibrotic treatment can be a challenge due to tolerability issues, the presence of pulmonary and extra-pulmonary comorbidities, and the need for concomitant medications in many patients. In general, making clear evidence-based decisions can be difficult for physicians because patients with comorbidities are often excluded from clinical trials. Since currently anti-fibrotic drugs are the only effective therapeutics capable of slowing disease progression, it is imperative that all treatment options are thoroughly evaluated and exhausted in each individual, irrespective of complicating factors, to permit the best outcome for the patient. In this review, we present data from clinical trials, post hoc analyses, post-marketing surveillance, and real-world studies that are relevant to the management of nintedanib treatment. In addition, we also provide practical recommendations developed by a multidisciplinary panel of experts for the management of nintedanib treatment in patients with IPF associated complications and those experiencing gastrointestinal side effects.

show abstract

“…No major side-effects occurred during the observation period, except for a significant weight loss due to drug-induced anorexia. Moreover, FVC values tended to stabilise after 12 weeks of treatment in most patients, and no post-operative thoracic wound healing problem, bleeding or severe anastomotic airway complications due to prior antifibrotic treatment were described [35]. Therefore, although only evaluated in a very limited number of case studies, antifibrotic drugs have been shown to be safe in IPF patients undergoing lung transplantation.…”

Section: When To Stop Therapymentioning

confidence: 99%

“…According to the most recent clinical trials evaluating antifibrotic drugs (2832 patients), only 11 patients, treated with pirfenidone, received transplants, and specific data on their outcomes are lacking. A recent study by DELANOTE et al [35] focused on this specific problem, and published the largest clinical series available. Nine patients with IPF treated with pirfenidone (n=7) or nintedanib (n=2) for a mean period of 13.4 months, who underwent lung transplantation, were evaluated for a median post-transplant follow-up of 19.8 months.…”

Section: When To Stop Therapymentioning

confidence: 99%

When to start and when to stop antifibrotic therapies

Torrisi¹,

Pavone²,

Vancheri³

et al. 2017

Eur Respir Rev

View full text Add to dashboard Cite

Idiopathic pulmonary fibrosis (IPF) is characterised by progressive changes of the lung architecture causing cough and dyspnoea and ultimately leading to lung failure and death. Today, for the first time, two drugs that may reduce the inexorable progression of the disease are available, suggesting that treatment with specific drugs for IPF should be started as soon as diagnosis is made. This applies to any disease and particularly to IPF, which is marked by a 5-year survival comparable or even worse than many cancers. However, despite common sense and even worse, in spite of scientific data coming from clinical trials, post hoc analysis, long-term safety studies and real-life experiences, the question of when to start and when to stop treatment with antifibrotics is still debated. In IPF, particularly when the disease is diagnosed at an early stage, "wait and watch" behaviour is not rare to observe. This is largely due to the lack of awareness of both patients and clinicians regarding the progression of the disease and its prognosis. Another important issue is when treatment should be stopped. In general, there are two main reasons to stop a therapy: unbearable side-effects and/or lack of efficacy. According to current (although preliminary) evidence, antifibrotic drugs should not be discontinued except for safety issues.

show abstract

Safety and efficacy of bridging to lung transplantation with antifibrotic drugs in idiopathic pulmonary fibrosis: a case series

Cited by 60 publications

References 18 publications

Pirfenidone safety and adverse event management in idiopathic pulmonary fibrosis

Pirfenidone safety and adverse event management in idiopathic pulmonary fibrosis

Nintedanib in Idiopathic Pulmonary Fibrosis: Practical Management Recommendations for Potential Adverse Events

When to start and when to stop antifibrotic therapies

Contact Info

Product

Resources

About