Antifibrotic drugs safe in idiopathic pulmonary fibrosis patients undergoing lung transplant
It is safe to administer antifibrotic drugs to patients with idiopathic pulmonary fibrosis, possibly reducing disease progression over time in those awaiting lung transplant, according to recent study results.
“With increasing use of antifibrotics following recent FDA approval, questions arise about their safety in idiopathic pulmonary fibrosis (IPF) patients undergoing lung transplant, yet safety data in this specific setting are currently lacking,” Isabelle Delanote, MD, from the department of respiratory disease at the University Hospitals Leuven in Belgium, and colleagues wrote. “Moreover, it is unclear whether antifibrotic treatment, when effectively achieving disease stabilization for several months, would influence lung allocation score or may even interfere with referral for lung transplant.”
In a single-center retrospective cohort analysis, the researchers assessed pretransplant pulmonary function, functional exercise capacity, and immediate and long-term post-operative outcomes to report on the safety and efficacy of antifibrotics in patients with IPF undergoing lung transplant. The study included nine IPF patients who had undergone lung transplant at Leuven University Hospitals whilst being treated with the antifibrotic therapy — either pirfenidone (Esbriet, Genentech) or nintedanib (Ofev, Boehringer Ingelheim).
No major side effects occurred, although significant weight loss was observed during antifibrotic treatment (P = .0062). In most patients, forced vital capacity (FVC) stabilized after 12 weeks of treatment, but functional exercise capacity and lung allocation score remained the same. The researchers noted a decline in FVC, total lung capacity and diffusion capacity during the entire pretransplant time period of antifibrotic therapy.
“Larger, preferably prospective, case-series are undeniably needed to confirm our findings, especially for nintedanib, additional safety data are needed before firmer conclusions can be made regarding its safety,” Delanote and associates concluded. “By attenuating disease progression while awaiting lung transplant, these antifibrotics may perhaps further help to reduce the number of IPF patients dying on the waiting list.” – by Savannah Demko
Disclosure: The researchers report no relevant financial disclosures.