Treatment Discontinuation in Idiopathic Pulmonary Fibrosis: A Systematic Review of Antifibrotic Drug Use and Tolerability
Author(s)
Sukannya Mahapatra, Nidhun Kandoth, M Pharm, Vyshnavi Telukuntla, Pharm D, Ankit Rohilla, M Pharm, Inderpreet Singh Khurana, M Pharm.
Lumanity, Gurugram, India.
Lumanity, Gurugram, India.
OBJECTIVES: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrosing interstitial lung disease of unknown aetiology. This systematic review assessed the rates of and reasons for treatment discontinuation in patients with IPF.
METHODS: A comprehensive literature search was conducted in Embase® and Medline® from inception to present for English-language full-text articles reporting discontinuation data.
RESULTS: A total of 1,503 full-text articles were screened; 29 met inclusion criteria and 14 were prioritized for analysis. Most were observational studies, i.e. retrospective (n=9) and prospective (n=5). Over half (n=8) were conducted in Europe (France: 3; multiple countries: 2; Germany, Spain, and England: 1 each), followed by Japan (n=3), Korea (n=2), and the US (n=1). Pirfenidone and nintedanib were the most commonly studied antifibrotic therapies. Five studies assessed pirfenidone alone, six both drugs, and three nintedanib alone. Discontinuation was mainly due to adverse events (AEs; 50%), followed by lack of efficacy (18%), refusal/non-compliance (15%), and financial/administrative reasons (17%). Common AEs for pirfenidone included anorexia (11%), rash (11%), and gastrointestinal issues (10%); for nintedanib, anorexia (3%), nausea (2%), and weight loss (2%). In a Spanish study, discontinuation was higher for nintedanib (64%) than pirfenidone (54.4%). A French study reported 51.5% of patients receiving pirfenidone discontinued within 12 months (mean time to discontinuation [SD]: 126.4 [91.4] days), compared with 43.8% receiving nintedanib (142.5 [95.7] days). In Japan, discontinuation rates were higher among elderly than younger patients (65% vs 36%; p=0.007). A European registry (n=1,099) reported median (IQR) time to pirfenidone discontinuation as 249.0 (90.0-461.0) days in France, 176.0 (60.0-401.0) in Germany, and 201.5 (88.0-398.0) in the UK, which had the highest early discontinuation rate (79.3%).
CONCLUSIONS: Antifibrotic therapy discontinuation in IPF is frequent, primarily driven by AEs, with notable variation by region, age, and treatment. Improved management of side effects may enhance adherence.
METHODS: A comprehensive literature search was conducted in Embase® and Medline® from inception to present for English-language full-text articles reporting discontinuation data.
RESULTS: A total of 1,503 full-text articles were screened; 29 met inclusion criteria and 14 were prioritized for analysis. Most were observational studies, i.e. retrospective (n=9) and prospective (n=5). Over half (n=8) were conducted in Europe (France: 3; multiple countries: 2; Germany, Spain, and England: 1 each), followed by Japan (n=3), Korea (n=2), and the US (n=1). Pirfenidone and nintedanib were the most commonly studied antifibrotic therapies. Five studies assessed pirfenidone alone, six both drugs, and three nintedanib alone. Discontinuation was mainly due to adverse events (AEs; 50%), followed by lack of efficacy (18%), refusal/non-compliance (15%), and financial/administrative reasons (17%). Common AEs for pirfenidone included anorexia (11%), rash (11%), and gastrointestinal issues (10%); for nintedanib, anorexia (3%), nausea (2%), and weight loss (2%). In a Spanish study, discontinuation was higher for nintedanib (64%) than pirfenidone (54.4%). A French study reported 51.5% of patients receiving pirfenidone discontinued within 12 months (mean time to discontinuation [SD]: 126.4 [91.4] days), compared with 43.8% receiving nintedanib (142.5 [95.7] days). In Japan, discontinuation rates were higher among elderly than younger patients (65% vs 36%; p=0.007). A European registry (n=1,099) reported median (IQR) time to pirfenidone discontinuation as 249.0 (90.0-461.0) days in France, 176.0 (60.0-401.0) in Germany, and 201.5 (88.0-398.0) in the UK, which had the highest early discontinuation rate (79.3%).
CONCLUSIONS: Antifibrotic therapy discontinuation in IPF is frequent, primarily driven by AEs, with notable variation by region, age, and treatment. Improved management of side effects may enhance adherence.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
PCR247
Topic
Patient-Centered Research
Topic Subcategory
Adherence, Persistence, & Compliance
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)