Pirfenidone Treatment for Interstitial Lung Disease

Patient Selection

• The European Respiratory Society recommends pirfenidone for patients with mild-to-moderate ILD, specifically those with FVC > 50% predicted and DLCO > 35% predicted 1, 2, 3

Efficacy

• Pirfenidone has demonstrated efficacy in reducing the decline in forced vital capacity (FVC) in patients with IPF, with a pooled analysis showing a 30% reduction in the risk of disease progression (HR 0.70, 95% CI 0.56–0.88) 4, 5

Special Considerations

• The European Respiratory Society advises against concomitant use of omeprazole with pirfenidone as it may alter pirfenidone pharmacokinetics 2
• Smoking should be discontinued prior to and during treatment as it increases the metabolism of pirfenidone, and patients should be warned about UV exposure and photosensitivity risk 1, 2, 3

Monitoring Requirements

• The European Respiratory Society recommends regular assessment of clinical tolerance, monitoring for disease progression with pulmonary function tests, and liver function tests prior to treatment initiation, monthly for the first 6 months, and every 3 months thereafter 1, 2, 3, 4, 5