Although patients with idiopathic pulmonary fibrosis (IPF) who take Ofev (nintedanib) or Esbriet (pirfenidone) have similar clinical outcomes, adherence to treatment is higher among those who have secondary insurance coverage, especially from charitable organizations, a study finds.
The study, “Retrospective Analysis of Medication Utilization and Clinical Outcomes in Patients With Idiopathic Pulmonary Fibrosis Treated With Nintedanib or Pirfenidone,” was published in Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine.
IPF is characterized by lung tissue damage and respiratory problems due to the formation of scars that impair gas exchange and prevent normal ventilation. This results in limitations in exercising, reduced quality of life, and ultimately a shortened life span. After an IPF diagnosis, the median survival for these patients is about three to five years.
Ofev inhibits receptor tyrosine kinases, which are thought to be involved in IPF development. How Esbriet works is unclear, but evidence suggests that it acts as an anti-fibrotic agent by blocking transforming growth factor (TGF)-beta and tumor necrosis factor (TNF)-alpha.
Both therapies have been shown to reduce disease progression in mild IPF cases, but comparisons between them are lacking about side effects, and treatment discontinuation and adherence.
Therefore, the researchers in the study evaluated the clinical records of patients who were first prescribed Ofev or Esbriet between January 2015 and December 2016 and filled their prescription at a national specialty pharmacy for more than two years. A total of 3,927 IPF patients were included in the study, 76% of whom were older than 65 years, and 61% were male. More than half of the patients were taking Ofev, while 1,322 patients received Esbriet.
Fifty four percent of the patients on Ofev reported at least one side effect, with diarrhea being the most common and affecting 54%, followed by nausea/vomiting (16%), and abdominal pain (5%). While in the Esbriet group, 42% of the patients reported at least one side effect, including nausea/vomiting (17%), diarrhea (16%), fatigue (10%), loss of appetite (9%), and indigestion (6%).
Ofev cost patients an average $235 per month (range was from $0 up to $8,104), and Esbriet cost an average $339 per month (range from $0 to $4,449).
Adherence to treatment was similar in both groups, with an average proportion of days covered of 84.2% for Ofev and 83.4% for Esbriet. The team found that treatment adherence was influenced by payer type. Patients with a secondary insurance coverage type, especially if this coverage was from a charitable organization, had greater adherence to the treatment than those with no secondary insurance.
In the Ofev group, the mean adherence rate for patients with additional charitable organization coverage was 85.9% compared with 67.7% among those with no secondary coverage. Those with primary commercial insurance coverage alone showed a mean adherence to Ofev of 70.7%.
Women in this group were about half as likely to be adherent as men, with a mean adherence rate of 69.5% compared with 81.2% for men.
In the Esbriet group, the mean adherence of patients with charitable organization coverage was 88.3% compared with 39.2% for those with no secondary coverage and 66.8% for those with primary coverage only.
These results demonstrate that adherence to IPF treatment is improved by about three to four fold if supported by charitable organization coverage.
“Continued utilization of (Ofev) nintedanib and (Esbriet) pirfenidone in the IPF population will help further establish the place in therapy for these medications, as well as impact patient outcomes through developed prescribing patterns and adverse event management,” the researchers wrote.
Adherence to treatment is positively influenced by secondary insurance coverage type, especially in the case of charitable organization coverage, which may ease “financial burden to some capacity,” they said.