Pirfenidone (Esbriet) May Prevent Acute Flares in IPF Patients After Lung Cancer Surgery

Treating idiopathic pulmonary fibrosis (IPF) patients with pirfenidone before and after lung surgery could help to protect them against acute exacerbation, or worsening of IPF, a life-threatening complication associated with lung cancer surgery.

This finding is detailed in the study, “Effect of Perioperative Pirfenidone Treatment in Lung Cancer Patients With Idiopathic Pulmonary Fibrosis,” published in the medical journal The Annals of Thoracic Surgery.

Pirfenidone is an approved IPF treatment to slow decline in lung function. In the U.S. and EU, it is available under the brand name Esbriet; in Japan, where this research took place, it is marketed as Pirespa.

Researchers led by Dr. Ichiro Yoshino, with the Department of General Thoracic Surgery at Chiba University, analyzed 50 lung cancer patients with IPF who underwent surgery between October 2006 and October 2014 at the university’s hospital.

A total of 31 patients received pirfenidone four weeks before and four weeks after the surgery, while the remaining 19 did not. There were no statistically significant differences between the two groups in terms of age, smoking history, sex, lung function (as measured by vital capacity), incidence of pneumonia, surgical procedure, or risk score.

Researchers then compared clinical outcomes for all patients at 30 and 90 days after the operation. The results found no incidences of acute IPF exacerbation within 30 days of surgery in those patients treated with pirfenidone, while 10.5% of the patients who did not receive the drug had an acute exacerbation. At 90 days post-surgery, these percentages were 3.2% for those given pirfenidone and 21.1% for patients who did not receive the drug.

Treating IPF patients with pirfenidone before and after lung cancer surgery “appears to be a promising strategy” to prevent acute exacerbations, the researchers wrote. They also stressed that confirmatory prospective studies should be conducted to further analyze the protective effect of pirfenidone treatment.

Acute exacerbation of IPF is defined as a sudden worsening of the condition, where the patient develops extreme breathing difficulty. Although this can happen without apparent reason, it is also often seen following lung cancer surgery.