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Respir Investig. 2014 Mar;52(2):136-43. doi: 10.1016/j.resinv.2013.09.002. Epub 2013 Oct 24.

Predictors of the clinical effects of pirfenidone on idiopathic pulmonary fibrosis.

Author information

1
Department of Respiratory Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan; Department of Diffuse Lung Diseases and Respiratory Failure, Clinical Research Center, National Hospital Organization, Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan. Electronic address: to-arai@kch.hosp.go.jp.
2
Department of Diffuse Lung Diseases and Respiratory Failure, Clinical Research Center, National Hospital Organization, Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan. Electronic address: giichi@kch.hosp.go.jp.
3
Department of Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan. Electronic address: yusasaki@kch.hosp.go.jp.
4
Department of Respiratory Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan; Department of Diffuse Lung Diseases and Respiratory Failure, Clinical Research Center, National Hospital Organization, Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan. Electronic address: ktachiba@kch.hosp.go.jp.
5
Department of Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan. Electronic address: keinakao@kch.hosp.go.jp.
6
Division of Clinical Trial, National Hospital Organization, Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan. Electronic address: sugimoto@kch.hosp.go.jp.
7
Department of Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka City, Osaka 545-8585, Japan. Electronic address: o-kuma@msic.med.osaka-cu.ac.jp.
8
Department of Radiology, National Hospital Organization, Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan. Electronic address: akira@kch.hosp.go.jp.
9
Department of Pathology, National Hospital Organization, Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan. Electronic address: kitaichi@kch.hosp.go.jp.
10
Department of Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, 1180 Nagasone-Cho, Kita-Ku, Sakai City, Osaka 591-8555, Japan. Electronic address: shayashi@kch.hosp.go.jp.

Abstract

BACKGROUND:

Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease with a poor prognosis. Recently, pirfenidone was reported to slow the rate of decline in vital capacity and improve progression-free survival in IPF. The purpose of this study was to clarify the factors that predicted a good response to pirfenidone, as well as its adverse effects.

METHODS:

Forty-one IPF cases, treated with pirfenidone from January 2009 to January 2011, were enrolled in this investigation. Disease severity was classified into grades I-IV, as defined by the Japanese Respiratory Society (JRS). Short-term responsiveness to pirfenidone was evaluated by the modified criteria of the JRS. Predictors of nausea, anorexia, or both that represented important adverse effects were examined by multivariate Cox proportional hazard analyses. Predictors of short-time responsiveness were examined by multivariate logistic regression analyses.

RESULTS:

Diagnosed by a surgical lung biopsy (SLB), the mild cases of grade I/II were predictors of good, short-term responsiveness. Patients taking acid-secretion inhibitors, including proton pump inhibitors and histamine H2-receptor antagonists, showed less anorexia, nausea, or both. Only 1 case was administered drugs to activate gastrointestinal motility.

CONCLUSIONS:

We concluded that IPF patients with a mild disease, diagnosis by SLB, or both showed indications of a good response to pirfenidone. In addition, acid-secretion inhibitors may reduce the frequency of anorexia, nausea, or both from pirfenidone.

KEYWORDS:

Acid-secretion inhibitors; Anorexia; Idiopathic pulmonary fibrosis; Pirfenidone

PMID:
24636270
DOI:
10.1016/j.resinv.2013.09.002
[Indexed for MEDLINE]
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