This article is part of Pulmonology Advisor’s coverage of the American Thoracic Society Virtual 2020 meeting.


In patients with idiopathic pulmonary fibrosis (IPF), treatment with pirfenidone was associated with a lower risk of mortality and acute respiratory-related hospitalizations than treatment with nintedanib, but more patients taking pirfenidone discontinued treatment by 12 months, according to findings presented virtually at the American Thoracic Society (ATS) 2020 Virtual meeting, held August 5 to 10, 2020.

The study included French National Health System claims data of patients aged ≥50 years with IPF who received their diagnosis between January 2015 and December 2016. Investigators estimated the cumulative incidence rates for untreated and patients newly treated with nintedanib (n=509) or pirfenidone (n=804). Additionally, patients treated with nintedanib or pirfenidone were compared in terms of all-cause mortality, acute respiratory-related hospitalizations, and treatment discontinuations.

At 3 years, the cumulative all-cause mortality was 50.23% (95% CI, 48.34%-52.09%) in 5360 untreated patients, 25.5% (95% CI, 19.6%-31.7%) in patients treated with pirfenidone, and 31.1% (95% CI, 21.2%-41.6%) in patients treated with nintedanib.


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In an analysis adjusted for age at index date, sex, year of index date, time in months between IPF diagnosis and index date, and proxies of severity in the 12 months prior to the index date, treatment with nintedanib correlated with a significantly higher risk of all-cause mortality (hazard ratio [HR], 1.80; 95% CI, 1.25-2.60) and acute respiratory-related hospitalization (HR, 1.32; 95% CI, 1.01-1.73) compared with treatment with pirfenidone. Additionally, treatment with nintedanib was associated with a significantly lower risk of treatment discontinuation than pirfenidone at 12 months (HR, 0.72; 95% CI, 0.60- 0.86).

Although the study was limited by its observational design, the investigators wrote that the “findings suggest possible differences in effectiveness between available drugs for IPF.”

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Reference

Cottin V, Spagnolo P, Bonniaud P, et al. Outcomes in patients receiving nintedanib or pirfenidone for idiopathic pulmonary fibrosis. Presented at: American Thoracic Society 2020 Virtual meeting; August 5-10, 2020. Abstract #725.