In patients receiving antifibrotic agents, a reduction in the risk of acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) may be greater for pirfenidone than for nintedanib, according to the results of a retrospective study published in Respiratory Medicine.

AE-IPF is a fatal event that can occur during the clinical course of IPF; however, data from clinical trials suggest that the antifibrotic agents pirfenidone and nintedanib could reduce the risk of AE-IPF. Researchers therefore sought to determine the incidence of AE-IPF in patients receiving antifibrotic agents and compare it with that of patients receiving pirfenidone and nintedanib.

The clinical records of 199 patients with IPF who were started on pirfenidone or nintedanib were reviewed during the period from 2009 through 2018. Baseline characteristics, incidence of AE-IPF, and outcome after AE-IPF onset were analyzed.

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During the observation period, the researchers found that the 1-, 2-, and 3-year cumulative incidences of AE-IPF were 9.3%, 22.1%, and 25.0%, respectively. The 1-, 2-, and 3-year cumulative incidence rates for AE-IPF in the pirfenidone group were 5.1%, 20.4%, and 22.6% compared with 18.6%, 25.2%, and 29.6% in the nintedanib group, respectively.

The incidence of AE-IPF was significantly lower in patients treated with pirfenidone compared with those treated with nintedanib (log rank test, P=.035). The 3-month survival rate after AE-IPF onset was determined to be 61.1% in the pirfenidone group and 61.5 % in the nintedanib group, reflecting similar outcomes after AE-IPF onset with both agents.

“Our real-world experience suggests that pirfenidone has a greater effect than nintedanib on suppressing AE-IPF incidence,” concluded the authors. They added, “Although these data deepen our understanding of IPF treatment, a large-scale study is necessary to confirm the present results.”


Isshiki T, Sakamoto S, Yamasaki A, et al. Incidence of acute exacerbation of idiopathic pulmonary fibrosis in patients receiving antifibrotic agents: real-world experience. Respir Med. Published online July 26, 2021. doi:10.1016/j.rmed.2021.106551

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