Switching Between Antifibrotics May Help IPF Patients Live Longer
Switching antifibrotic treatment is generally well-tolerated among people with idiopathic pulmonary fibrosis (IPF), and those who did generally lived several years longer than those who did not, a study from Japan reports.
Findings suggest that switching from one antifibrotic to another “is feasible and may improve prognosis [disease course] in patients with IPF,” its researchers wrote.
The study, “Switching antifibrotics in patients with idiopathic pulmonary fibrosis: a multi-center retrospective cohort study,” was published in the journal BMC Pulmonary Medicine.
Antifibrotics, as the name suggests, are medications that work to reduce fibrosis, or tissue scarring. Two are currently used to treat IPF: Ofev (nintedanib) marketed by Boehringer Ingelheim, and Esbriet (pirfenidone) marketed by Genentech. These two medicines have different mechanisms of action, but both have been shown to slow lung function decline in people with IPF.
In clinical practice, it is not uncommon for patients to switch between medications, due to adverse reactions to a medicine or disease progression. However, the safety and effectiveness of switching between antifibrotic medications for IPF patients has not yet been assessed, the researchers noted.
A team led by scientists at Hamamatsu University School of Medicine in Japan reviewed clinical data on 262 IPF patients who were treated with Ofev, Esbriet, or both medications between 2009 and 2020.
Among them, 37 (14.1%) switched antifibrotic treatment: 29 switched from Esbriet to Ofev, and the remaining eight from Ofev to Esbriet. The most common reasons for switching were disease progression and gastrointestinal side effects.
Most of those who switched tolerated the second medicine well, with eight of these patients discontinuing the new treatment due to side effects.
“These results suggest that second-line antifibrotics are generally feasible,” the researchers wrote.
The median survival time from treatment start was significantly longer for patients who switched medications, compared with those who did not (67.2 vs. 27.1 months, or about 3.3 years). The five-year survival rate also was significantly higher among patients who switched therapies (52.1% vs. 11.2%, or about 3.4 years). Yet, causes of death were similar in both groups.
“Collectively, these results suggest that switching antifibrotics from one to another may improve the prognosis among patients discontinuing first-line antifibrotics due to [side effects] or those showing disease progression despite treatment,” the researchers wrote.
Reasons for this difference are not entirely clear, the researchers noted. But since Ofev and Esbriet work in the body through different mechanisms, it is possible that “sequential administration of two antifibrotics with distinct mechanisms of action may provide clinical benefits, especially if the first-line antifibrotics are not effective enough.”
The team acknowledged the study had several limitations, including its retrospective nature and relatively small sample size. They emphasized the need for further research into the benefits and risks of switching antifibrotic therapies.