Nationwide Study Reveals Esbriet Use Patterns by PF Patients in Sweden

Nationwide Study Reveals Esbriet Use Patterns by PF Patients in Sweden

A comprehensive Swedish study reveals low use and lack of persistence with Esbriet (pirfenidone) treatment among patients with pulmonary fibrosis (PF).

Results of this real-world study were presented in a poster titled “Pirfenidone Use in a Swedish Cohort of Patients With Pulmonary Fibrosis” during the European Respiratory Society (ERS) International Congress 2018, held in Paris, France, Sept. 15-19.

Esbriet, marketed by Genentech, has been available in Europe for the treatment of idiopathic pulmonary fibrosis (IPF) since its approval in 2011. (It also is approved for IPF in the U.S. and Asia.) The medication has been effective in reducing disease progression rates compare to placebo in several clinical trials. It is currently recommended by IPF international guidelines for the treatment of the majority of patients with the disease.

The team of researchers at Karolinska Institutet explored the real-wold treatment patterns with Esbriet in PF patients in Sweden. They reviewed the clinical records of 17,247 PF patients in the Swedish National Patient Register from 2001 to 2015.

More detailed information collected from electronic medical records obtained from primary care and four respiratory clinics in Stockholm and Uppsala was used to identify patients with IPF. A total of 291 patients with a diagnosis of IPF were included in the analysis.

Results showed that since 2011 Esbriet was prescribed at least once as a treatment for 3% of PF patients, and 26.7% of IPF patients. In the majority of cases, the treatment was prescribed more than one year after diagnosis.

The data revealed that Esbriet use was lower than expected in the Swedish PF population, compared to data from a prior study that indicated an antifibrotic prescription rate of 69.4% from 2014 to 2016. This suggests that use of this therapy “was low during the early years of its introduction” in the market, the researchers wrote.

The estimated median treatment dose used by PF and IPF patients was 2,190.2 and 2,225.4 mg per day, respectively.

Long-term follow-up data revealed that patients with PF continued the treatment for 297 days (median), and only 41.8% of patients persisted for at least one year. In the IPF group, median persistence was 212 days, and 29.8% of patients continued the treatment for at least one year. Still, median adherence to Esbriet was 100% during treatment duration.

Although the adherence was very good, a large proportion of patients were found to discontinue the treatment within the first six months. The researchers believed this probably is due to common adverse side effects related to the treatment that are likely to occur during this time period.

Overall, the team suggested that “the lack of persistence with pirfenidone underscores the importance of supporting and guiding patients to persist with their medications to ensure maximal benefit of treatment.”

The researchers also emphasized that the delayed prescription of Esbriet potentially may lead to “missed opportunities for patients to receive an effective treatment at an early stage of their disease.”

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  1. Timothy Middleton says:

    I don’t understand the point of this article. Not be rude, this seems like a marketing problem for the manufacturer.

  2. Donald Otis says:

    No, the thing is, Genentech learned from these trials. I am one in the US who has persisted on Esbriet since diagnosed with IPF in 2015. I, like many, had severe side effects, and actually stopped in order to try Ofev.

    Initially, pirfenidone was formulated as capsules, which dissolved in the stomach. They have reformulated the same dosage into pills, which substantially reduced the nausea associated with the medicine.

    The point here is that a) the stuff was hard on the system, and that b) causes people to stop using it, so the doctors need to push to keep them moving through it.

    It leaves out that they can change to the 801 pill format after titrate, and add odansetron (Zofran) immediately on prescription of Esbriet, and avoid the worst side effects of the routine.

    • Sandra Garza says:

      Thank you for responding. I had no idea there is pill format. My mom is on capsules and is on a reduced dosage of Esbriet. She is supposed to take 3 capsules 3x per day but can only tolerate 2 capsules 3x per day. I will bring up change with her doctor. I was thinking the cost of the drug would cause many patients to stop treatment. Isn’t there a study that concluded that a lower dose still had same benefits of higher dose? One benefit of lower dose is her prescription lasts longer. The cost of her first year on medication was manageable as she was hospitalized 3x. Now, after 1 year of Esbriet treatment,respiratory therapy, and acid reflux medication, she is stable. No further hospitalizations. We are so grateful but the down side is that the cost of medication is comparable to mortgage payment.

  3. My husband has IPF… diagnosed September 2015… last part of 2016 was put on OFEV… took for 8 months then like a tsunami was hit with diarrhea .. lost 15 lbs in 3 weeks… Dr took him off that …December 2017 was put on Esbriet… no side effects.. close to a year now.

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