Role of pirfenidone in the management of pulmonary fibrosis

• Published in: Therapeutics and clinical risk management Vol. 13; pp. 427 - 437
• Main Authors: Meyer, Keith C, Decker, Catherine A
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2017; Taylor & Francis Ltd; Dove Medical Press
• Subjects: Age; Cardiovascular disease; Care and treatment; Clinical medicine; Clinical trials; Complications and side effects; Development and progression; Diagnosis; Dosage and administration; Drug therapy; FDA approval; idiopathic pulmonary fibrosis; interstitial lung disease; Interstitial lung diseases; Lung diseases; Medical prognosis; Medicine; Mortality; Pirfenidone; Pneumonia; Prognosis; Pulmonary fibrosis; Respiration; Review; Transplants & implants; treatments; United States > US; idiopathic pulmonary fibrosis; interstitial lung disease; pirfenidone; treatments
• ISSN: 1176-6336; 1178-203X; 1178-203X
• DOI: 10.2147/tcrm.s81141

Pulmonary fibrosis is associated with a number of specific forms of interstitial lung disease (ILD) and can lead to progressive decline in lung function, poor quality of life, and, ultimately, early death. Idiopathic pulmonary fibrosis (IPF), the most common fibrotic ILD, affects up to 1 in 200 elderly individuals and has a median survival that ranges from 3 to 5 years following initial diagnosis. IPF has not been shown to respond to immunomodulatory therapies, but recent trials with novel antifibrotic agents have demonstrated lessening of lung function decline over time. Pirfenidone has been shown to significantly slow decline in forced vital capacity (FVC) over time and prolong progression-free survival, which led to its licensing by the United States Food and Drug Administration (FDA) in 2014 for the treatment of patients with IPF. However, pirfenidone has been associated with significant side effects, and patients treated with pirfenidone must be carefully monitored. We review recent and ongoing clinical research and experience with pirfenidone as a pharmacologic therapy for patients with IPF, provide a suggested approach to incorporate pirfenidone into a treatment algorithm for patients with IPF, and examine the potential of pirfenidone as a treatment for non-IPF forms of ILD accompanied by progressive pulmonary fibrosis.