Pirfenidone vs. nintedanib in patients with idiopathic pulmonary fibrosis: a retrospective cohort study

• Published in: Respiratory research Vol. 22; no. 1; p. 268
• Main Authors: Marijic, Pavo, Schwarzkopf, Larissa, Schwettmann, Lars, Ruhnke, Thomas, Trudzinski, Franziska, Kreuter, Michael
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 19.10.2021; BioMed Central; BMC
• Subjects: Administrative data; Aged; Aged, 80 and over; Ambulatory Care - economics; Analysis; Antifibrotic Agents - adverse effects; Antifibrotic Agents - economics; Antifibrotic Agents - therapeutic use; Drug Costs; Drug therapy; Drugs; Female; Health care costs; Hospital Costs; Hospitalization; Humans; Idiopathic pulmonary fibrosis; Idiopathic Pulmonary Fibrosis - diagnosis; Idiopathic Pulmonary Fibrosis - drug therapy; Idiopathic Pulmonary Fibrosis - economics; Idiopathic Pulmonary Fibrosis - mortality; Indoles - adverse effects; Indoles - economics; Indoles - therapeutic use; Male; Medical care, Cost of; Middle Aged; Mortality; Patient outcomes; Pulmonary fibrosis; Pyridones - adverse effects; Pyridones - economics; Pyridones - therapeutic use; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Germany; Drugs; Health care costs; Idiopathic pulmonary fibrosis; Mortality; Statutory health insurance; Administrative data; Hospitalization
• ISSN: 1465-993X; 1465-9921; 1465-993X
• DOI: 10.1186/s12931-021-01857-y

Two antifibrotic drugs, pirfenidone and nintedanib, are licensed for the treatment of patients with idiopathic pulmonary fibrosis (IPF). However, there is neither evidence from prospective data nor a guideline recommendation, which drug should be preferred over the other. This study aimed to compare pirfenidone and nintedanib-treated patients regarding all-cause mortality, all-cause and respiratory-related hospitalizations, and overall as well as respiratory-related health care costs borne by the Statutory Health Insurance (SHI). A retrospective cohort study with SHI data was performed, including IPF patients treated either with pirfenidone or nintedanib. Stabilized inverse probability of treatment weighting (IPTW) based on propensity scores was applied to adjust for observed covariates. Weighted Cox models were estimated to analyze mortality and hospitalization. Weighted cost differences with bootstrapped 95% confidence intervals (CI) were applied for cost analysis. We compared 840 patients treated with pirfenidone and 713 patients treated with nintedanib. Both groups were similar regarding two-year all-cause mortality (HR: 0.90 95% CI: 0.76; 1.07), one-year all cause (HR: 1.09, 95% CI: 0.95; 1.25) and respiratory-related hospitalization (HR: 0.89, 95% CI: 0.72; 1.08). No significant differences were observed regarding total (€- 807, 95% CI: €- 2977; €1220) and respiratory-related (€- 1282, 95% CI: €- 3423; €534) costs. Our analyses suggest that the patient-related outcomes mortality, hospitalization, and costs do not differ between the two currently available antifibrotic drugs pirfenidone and nintedanib. Hence, the decision on treatment with pirfenidone versus treatment with nintedanib ought to be made case-by-case taking clinical characteristics, comorbidities, comedications, individual risk of side effects, and patients' preferences into account.