There are two potent antifibrotics, nintedanib and pirfenidone, that are successful in treating the severe interstitial lung condition known as idiopathic pulmonary fibrosis (IPF). The consequences of reducing the amount of an antifibrotic medication are unclear, yet many patients have their dosage lowered or their treatment stopped altogether owing to negative effects.

In a sizable real-life IPF cohort, researchers retrospectively looked at the effect of antifibrotic therapy decrease on mortality. Time until death from any cause was the analysis’s main outcome. Based on treatment intensity (full, decreased, or no therapy), and the antifibrotic medication type, 5 patient groups were established (pirfenidone or nintedanib). Utilizing Cox proportional hazards analysis with baseline adjustments for age, sex, smoking status, and lung function, between group survival was compared.

From April 2016 to November 2021, 375 patients from the Danish PFBIO-cohort were monitored, with a median follow-up duration of 1.84 years. When taking into account the complete follow-up period, patients receiving nintedanib and pirfenidone had decreased therapy in proportions of 80.19% and 67.42%, respectively. Independent of treatment intensity, nintedanib, and pirfenidone medication was linked to enhanced survival compared to no antifibrotic treatment (nintedanib: HR: 0.31, 95%-CI: 0.19-0.53, P< 0.001; pirfenidone: HR: 0.26, 95%-CI: 0.16-0.42, P< 0.001). Lower doses of nintedanib and pirfenidone were not linked to inferior survival results.

To lessen the negative effects brought on by a full dose regimen of antifibrotic medication, a sizable number of individuals with IPF undergo decreased antifibrotic therapy. In terms of improving survival, treatment with nintedanib and pirfenidone was preferable to no antifibrotic treatment, regardless of the intensity of the treatment, and a reduced dose seems like a good alternative if the full dose is not tolerated.

Reference: resmedjournal.com/article/S0954-6111(22)00280-3/fulltext