A team of German researchers compared 2 antifibrotic drugs commonly prescribed for idiopathic pulmonary fibrosis (IPF), pirfenidone and nintedanib, and discovered that patient-related parameters such as mortality, hospitalization, and costs did not differ significantly between them, according to a paper published in Respiratory Research.

The researchers wrote, “Both drugs have been shown to slow IPF progression, to increase survival, and to reduce respiratory-related hospitalizations.” However, there are currently no guidelines that dictate when one drug should be preferred over the other.

Studies directly comparing these 2 antifibrotic medications are also scarce. “Comparative observational studies, especially in real-world settings are also rare and show inconclusive results on survival differences between the drugs,” the research team commented. 

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Marijic et al conducted a retrospective cohort study to see if any statistically significant differences in patient outcomes could be observed between the 2 drugs. They recruited patients with IPF through health insurance claims data provided by a research institute. This method of data collection is less prone to selection bias than primary data.

The researchers then analyzed the medications that the IPF patients were prescribed and separated them into 2 cohorts: patients prescribed pirfenidone (n=840) and patients prescribed nintedanib (n=713). Therapy initiation was defined as the date that the patients first redeemed their prescriptions. 

The researchers discovered that patient-related outcomes for both drugs were similar. Both cohorts were statistically similar in terms of 2-year all-cause mortality, 1-year all-cause hospitalization, and respiratory-related hospitalization. There were also no statistical differences between the drugs in terms of respiratory-related and total treatment-related expenditures. 

In view of these findings, the researchers concluded that “the decision to treat with pirfenidone and nintedanib should be made on a case-by-case basis taking into account clinical characteristics including comorbidities and comedication, individual risk for adverse events, and patient preferences.”


Marijic P, Schwarzkopf L, Schwettmann L, Ruhnke T, Trudzinski F, Kreuter M. Pirfenidone vs. nintedanib in patients with idiopathic pulmonary fibrosis: a retrospective cohort studyRespir Res. 2021;22(1):268. doi:10.1186/s12931-021-01857-y

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