Dinesh Khanna1, Carlo Albera2, Aryeh Fischer2, Nader Khalidi2, Ganesh Raghu2, Lorinda Chung2, Dan Chen2, Elena Schiopu2, Margit Tagliaferri2, James R Seibold2, Eduard Gorina2. 1. From the University of Michigan, Ann Arbor, Michigan; University of Colorado, Denver, Colorado; University of Washington, Seattle, Washington; Stanford University School of Medicine; Jazz Pharmaceuticals, Palo Alto; InterMune Inc., Brisbane, California; Scleroderma Research Consultants LLC, Litchfield, Connecticut, USA; University of Turin, Turin, Italy; McMaster University, Hamilton, Ontario, Canada.D. Khanna, MD, MS, University of Michigan; C. Albera, MD, University of Turin; A. Fischer, MD, University of Colorado; N. Khalidi, MD, FRCPC, McMaster University; G. Raghu, MD, University of Washington; L. Chung, MD, Stanford University School of Medicine; D. Chen, MD, PhD, Jazz Pharmaceuticals, and formerly of InterMune; E. Schiopu, MD, University of Michigan; M. Tagliaferri, MD, formerly of InterMune; J.R. Seibold, MD, Scleroderma Research Consultants LLC; E. Gorina, MD, MS, formerly of InterMune. khannad@med.umich.edu. 2. From the University of Michigan, Ann Arbor, Michigan; University of Colorado, Denver, Colorado; University of Washington, Seattle, Washington; Stanford University School of Medicine; Jazz Pharmaceuticals, Palo Alto; InterMune Inc., Brisbane, California; Scleroderma Research Consultants LLC, Litchfield, Connecticut, USA; University of Turin, Turin, Italy; McMaster University, Hamilton, Ontario, Canada.D. Khanna, MD, MS, University of Michigan; C. Albera, MD, University of Turin; A. Fischer, MD, University of Colorado; N. Khalidi, MD, FRCPC, McMaster University; G. Raghu, MD, University of Washington; L. Chung, MD, Stanford University School of Medicine; D. Chen, MD, PhD, Jazz Pharmaceuticals, and formerly of InterMune; E. Schiopu, MD, University of Michigan; M. Tagliaferri, MD, formerly of InterMune; J.R. Seibold, MD, Scleroderma Research Consultants LLC; E. Gorina, MD, MS, formerly of InterMune.
Abstract
OBJECTIVE: Systemic sclerosis-associated interstitial lung disease (SSc-ILD) shares a number of clinical features and pathogenic mechanisms with idiopathic pulmonary fibrosis (IPF). This study was designed to evaluate the tolerability of the IPF treatment pirfenidone in SSc-ILD. The known gastrointestinal, skin, and liver adverse events (AE) of pirfenidone are of importance given the involvement of these organs in SSc. METHODS: All patients received pirfenidone and were randomized 1:1 to either a 2- or 4-week titration starting at 801 mg/day and finishing at a maintenance dose of 2403 mg/day. Patients received pirfenidone for 16 weeks in total. Assessments included treatment-emergent AE (TEAE) and exploratory disease outcomes. RESULTS: Sixty-three patients were randomized; 96.8% experienced a TEAE and more patients reported TEAE during the titration versus the maintenance period. The most commonly reported TEAE were consistent with those observed for pirfenidone in IPF (nausea, headache, fatigue) and were similar regardless of titration schedule. More patients discontinued treatment because of TEAE in the 2- versus 4-week titration group (5 vs 1, respectively); all discontinuation events occurred > 3 weeks after reaching the full dose of pirfenidone. Mycophenolate mofetil (MMF), taken by 63.5% of patients in addition to pirfenidone, did not appear to affect tolerability. Exploratory disease outcomes remained largely unchanged. CONCLUSION:Pirfenidone showed an acceptable tolerability profile in SSc-ILD, although a longer titration may be associated with better tolerability. Tolerability was not affected by concomitant MMF. The present findings support further investigation of pirfenidone in future clinical trials in patients with SSc-ILD. TRIAL REGISTRATION: ClinicalTrials.gov; www.clinicaltrials.gov NCT01933334.
RCT Entities:
OBJECTIVE: Systemic sclerosis-associated interstitial lung disease (SSc-ILD) shares a number of clinical features and pathogenic mechanisms with idiopathic pulmonary fibrosis (IPF). This study was designed to evaluate the tolerability of the IPF treatment pirfenidone in SSc-ILD. The known gastrointestinal, skin, and liver adverse events (AE) of pirfenidone are of importance given the involvement of these organs in SSc. METHODS: All patients received pirfenidone and were randomized 1:1 to either a 2- or 4-week titration starting at 801 mg/day and finishing at a maintenance dose of 2403 mg/day. Patients received pirfenidone for 16 weeks in total. Assessments included treatment-emergent AE (TEAE) and exploratory disease outcomes. RESULTS: Sixty-three patients were randomized; 96.8% experienced a TEAE and more patients reported TEAE during the titration versus the maintenance period. The most commonly reported TEAE were consistent with those observed for pirfenidone in IPF (nausea, headache, fatigue) and were similar regardless of titration schedule. More patients discontinued treatment because of TEAE in the 2- versus 4-week titration group (5 vs 1, respectively); all discontinuation events occurred > 3 weeks after reaching the full dose of pirfenidone. Mycophenolate mofetil (MMF), taken by 63.5% of patients in addition to pirfenidone, did not appear to affect tolerability. Exploratory disease outcomes remained largely unchanged. CONCLUSION:Pirfenidone showed an acceptable tolerability profile in SSc-ILD, although a longer titration may be associated with better tolerability. Tolerability was not affected by concomitant MMF. The present findings support further investigation of pirfenidone in future clinical trials in patients with SSc-ILD. TRIAL REGISTRATION: ClinicalTrials.gov; www.clinicaltrials.gov NCT01933334.
Authors: G S R S N K Naidu; Shefali Khanna Sharma; M B Adarsh; Varun Dhir; Anindita Sinha; Sahajal Dhooria; Sanjay Jain Journal: Rheumatol Int Date: 2019-12-07 Impact factor: 2.631