Effects of Pirfenidone on Polypharmacy in Idiopathic Pulmonary Fibrosis

Among patients with idiopathic pulmonary fibrosis (IPF), the use of pirfenidone does not delay new prescription of concomitant antitussive drugs; however, it may tend to delay respiratory adverse events and the need for new antibiotic prescriptions, according to results from an exploratory analysis published in CHEST.

A team of investigators in Japan conducted a post hoc exploratory analysis of a phase 3 multicenter, randomized, double-blind, placebo-controlled trial to determine the possible effects of pirfenidone in delaying the need to prescribe concomitant drugs to patients with IPF (registered with the Japan Pharmaceutical Information Center, JapicCTI-050121). The researchers assessed the effects of pirfenidone in delaying new prescriptions of antitussive drugs or antibiotics for respiratory adverse events, which included upper respiratory tract infection, pneumonia, and acute exacerbations of IPF.

In the phase 3 clinical trial, 267 patients were randomly assigned to either high-dose pirfenidone (n=108), low-dose pirfenidone (n=55), or placebo (n=104). During the 52 weeks of the study, 54% of patients were newly prescribed antibiotics and 57% were prescribed antitussive drugs; 39% of patients were prescribed both drug types during the observational period and 21% of patients were prescribed both simultaneously.

The median time from initiation of the trial drug to the prescription was 267 days for antibiotics and 217 days for antitussive drugs. Compared with the placebo, treatment with pirfenidone did not significantly delay new prescriptions of concomitant antitussive drugs (hazard ratio [HR], 0.875; P =.4122); however, pirfenidone tended to delay new onset of respiratory adverse events (HR, 0.751; P =.0560) and tended to delay the need for new antibiotics to treat respiratory adverse events (HR, 0.714; P =.0948).

“Our findings may indicate that pirfenidone has the potential to avoid polypharmacy by delaying the prescription of antibiotics,” the authors wrote. “Further studies will be warranted to confirm these findings.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Suzuki A, Sakaguchi H, Sakamoto K, et al. The effect of pirfenidone on the prescription of antibiotics and antitussive drugs in patients with idiopathic pulmonary fibrosis: a post-hoc exploratory analysis of phase III clinical trial. CHEST. Published online June 5, 2021. doi:10.1016/j.chest.2021.05.058