In patients with idiopathic pulmonary fibrosis (IPF), anorexia and weight loss during prior treatment with pirfenidone was associated with early termination of subsequent nintedanib therapy, according to study results published in BMC Pulmonary Medicine.

Patients with IPF who had discontinued treatment with pirfenidone due to a reduction in forced vital capacity (FVC) or an intolerable adverse event (AE) were enrolled (n=30) in the study. In addition, investigators retrospectively reviewed a subset of patients who had newly initiated twice-daily 150 mg nintedanib from September 2015 to August 2017 (switch-group).

Participants in the switch-group were compared with 64 patients with IPF who had newly initiated nintedanib therapy during the same period without prior antifibrotic treatment (pirfenidone-naïve group). Comparisons were made with regard to characteristics, treatment status, and adverse events (AEs).

The median body weight, body mass index (BMI), and percent predicted FVC in the switch-group were 54.9 kg, 21.0 kg/m2, and 52.9%, respectively. Anorexia was reported in 46.7% of patients during nintedanib therapy, whereas anorexia and ≥5% weight loss was found in 63.3% and 56.7% of patients, respectively, during pirfenidone administration. A total of 16 patients terminated nintedanib therapy early (ie, ≤6 months of administration).

According to the multivariate logistic regression analysis, there was a significant association between low BMI and early nintedanib discontinuation in the switch-group (P =.0239). In approximately 70% of patients, treatment with nintedanib was associated with suppression of FVC decline vs that observed during pirfenidone administration. Just before the start of nintedanib, the switch-group had significantly lower body weight (P =.01), BMI (P =.001), absolute FVC values (P =.001), and percent predicted FVC (P =.001). In addition, the switch-group had more frequently reported nintedanib-induced anorexia vs the pirfenidone-naïve group (P =.028).

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Study limitations included its retrospective design, the recruitment of patients from a single center, and the small sample size.

The researchers concluded that “further investigation is required to establish an optimal treatment strategy” for these patients.

Disclosures: Dr Ogura has received honorarium from Boehringer Ingelheim and Shionogi & Co., Ltd.

Reference

Ikeda S, Sekine A, Baba T, et al. Negative impact of anorexia and weight loss during prior pirfenidone administration on subsequent nintedanib treatment in patients with idiopathic pulmonary fibrosis. BMC Pulm Med. 2019;19(1):78.