• Stefania Cerri, Matteo Monari, Aldo Guerrieri, Pierluigi Donatelli, Ilaria Bassi, Martina Garuti, Fabrizio Luppi, Sara Betti, Gianpiero Bandelli, Marco Carpano, Maria Letizia Bacchi Reggiani, Roberto Tonelli, Enrico Clini, and Stefano Nava.
• Pneumology Unit, University Hospital of Modena Policlinico, Modena, Italy.
• Respir Med. 2019 Nov 1; 159: 105803.

BackgroundReal-life data on the use of pirfenidone and nintedanib to treat patients with idiopathic pulmonary fibrosis (IPF) are still scarce.MethodsWe compared the efficacy of either pirfenidone (n = 78) or nintedanib (n = 28) delivered over a 24-month period in patients with IPF, followed at two regional clinic centers in Italy, with a group of patients who refused the treatment (n = 36), and who were considered to be controls. All patients completed regular visits at 1- to 3-month intervals, where primary [forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide (DLCO)] and secondary outcomes (side effects, treatment compliance, and mortality) were recorded.ResultsOver time, the decline in FVC and DLCO was significantly higher (p = 0.0053 and p = 0.037, respectively) in controls when compared with the combined treated group, with no significant difference between the two treated groups. Compared to patients with less advanced disease (GAP (Gender, Age, Physiology) stage I), those in GAP stages II and III showed a significantly higher decline in both FVC and DLCO irrespective of the drug taken. Side effects were similarly reported in patients receiving pirfenidone and nintedanib (5% and 7%, respectively), whereas mortality did not differ among the three groups.ConclusionThis real-life study demonstrated that both pirfenidone and nintedanib were equally effective in reducing the decline of FVC and DLCO versus non-treated patients after 24 months of treatment; however, patients with more advanced disease were likely to show a more rapid decline in respiratory function.Copyright © 2019 Elsevier Ltd. All rights reserved.

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