Pirfenidone did not delay new prescription of concomitant antitussive drugs in IPF

In patients with idiopathic pulmonary fibrosis, pirfenidone delayed new-onset respiratory adverse events and antibiotic prescriptions, but did not delay new prescription of concomitant antitussive drugs compared with placebo.

“In multinational, phase 3 clinical trials, pirfenidone reduced disease progression as reflected by pulmonary function, exercise tolerance and progression-free survival in patients with IPF. Recent studies further demonstrated that pirfenidone reduces respiratory-related hospitalizations and objective cough,” Atsushi Suzuki, MD, from the department of respiratory medicine at Nagoya University Graduate School of Medicine in Aichi, Japan, and colleagues wrote in Chest. “Considering these findings, we posited that pirfenidone may reduce the prescription of antibiotics and antitussive drugs and contribute to the avoidance of polypharmacy.”

Researchers performed a post hoc exploratory analysis of a phase 3, multicenter, randomized, double-blind, placebo-controlled trial of patients with IPF in Japan that evaluated efficacy and safety of pirfenidone over 1 year. Patients were randomly assigned to high-dose pirfenidone 1,800 mg per day (n = 108), low-dose pirfenidone 1,200 mg per day (n = 55) or placebo (n = 104).

For the new analysis, researchers assessed the effect of pirfenidone in delaying new antitussive or antibiotic prescriptions for respiratory adverse events, including upper respiratory tract infection, pneumonia and acute IPF exacerbation.

During the 52-week study period, 54% of patients with IPF were newly prescribed antibiotics and 57% were newly prescribed antitussive drugs. The median time from trial initiation to prescription of antibiotics was 267 days, and the median time from trial initiation to prescription of antitussive drugs was 217 days. Thirty-nine percent of patients were prescribed both antibiotics and antitussive drugs during the study and 21% were prescribed both simultaneously.

Overall, pirfenidone did not delay new prescription of concomitant antitussive drugs compared with placebo (HR = 0.875; 95% CI, 0.635-1.205; P = .4122).

However, pirfenidone delayed new-onset respiratory adverse events (HR = 0.751; 95% CI, 0.56-1.007; P = .056) and new antibiotic use for new-onset respiratory adverse events (HR = 0.714; 95% CI, 0.481-1.06; P = .09) compared with placebo.

“To the best of our knowledge, this is the first study to assess the effect of pirfenidone on the prescription of concomitant drugs in IPF patients. ... Polypharmacy is reported to be present in more than half of IPF patients. Our findings indicate that pirfenidone has the potential to avoid polypharmacy by delaying the prescription of antibiotics,” the researchers wrote.

Further research is needed to confirm the findings, they wrote.