Clinical and pharmacological comparison of current antifibrotic drugs for therapy of idiopathic pulmonary fibrosis

Therapeutic options for idiopathic pulmonary fibrosis (IPF) have been significantly extended last decade due to clinical use of drugs with confirmed antifibrotic activity, nintedanib and pirfenidone. Results of completed randomized phase III clinical trials (RCT) showed the ability of these drugs to decrease IPF progression and all-cause mortality compared to placebo. No direct comparison of efficacy and safety of different pharmacothera-peutic regimens with nintedanib and pirfenidone in IPF patients was published. The pooled odds ratio for mortality was 0.70 (95% confidential interval (CI), 0.47 – 1.03) in three trials of nintedanib (INPULSIS-1, INPULSIS-2, and TOMORROW; 2015) and 0.70 (0.47 – 1.02) in three trials of pirfenidone (CAPACITY-1, CAPACITY-2, and ASCEND). RCTs evaluating clinical efficacy of nintedanib and pirfenidone were not designed to assessment of mortality as the primary end-point; the primary end-point in all the trials was the change in the forced vital capacity of the lungs. Published metaanalyses demonstrated similar effects of nintedanib and pirfenidone on all-cause mortality and mortality from respiratory causes and confirmed favourable effects of both the drugs on course and progression of IPF. © 2017 Medical Education. All rights reserved.