A retrospective study has found that idiopathic pulmonary fibrosis (IPF) patients taking pirfenidone (Esbriet®) may be at a reduced risk for acute exacerbations, compared to patients taking nintedanib (Ofev®).

During the study, which was published in Respiratory Medicine, the 1-, 2-, and 3-year cumulative incidence rates for each treatment group were compared. These analyses yielded rates of 5.1% vs 18.6%, 20.4% vs 25.2%, and 22.6% vs 29.6% for pirfenidone and nintedanib, respectively. Overall statistical analysis using a log-rank test found that the incidence of acute exacerbations was statistically higher in the nintedanib group compared to pirfenidone (P =.035).

The 3-month survival rates after acute exacerbation for both groups were similar, with the pirfenidone group having 61.1% survival compared to 61.5% for the nintedanib group.

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The authors stated, “Our real-world experience suggests that pirfenidone has a greater effect than nintedanib on suppressing AE-IPF incidence. Although these data deepen our understanding of IPF treatment, a large-scale study is necessary to confirm the present results.”

A total of 15.9% of IPF patients developed acute exacerbations over the entire follow-up period. The 1-, 2-, and 3-year cumulative incidence rates combined between both antifibrotic treatments were 9.3%, 22.1%, and 25.0%, respectively. While incidence rates of acute exacerbations were higher in the nintedanib group, overall survival after the initiation of antifibrotic treatments was not significantly different (log-rank test, P =.634).

The study analyzed clinical records from 199 patients of the Toho University Omori Medical Center in Japan between 2009 and 2018. A total of 195 of these patients were ultimately used in the statistical analyses after 2 patients were excluded due to treatment with both pirfenidone and nintedanib and 2 patients had acute exacerbations triggered by known causes. Of these 195 patients, 131 received pirfenidone while 64 received nintedanib. According to the study’s authors, the higher number of patients receiving pirfenidone was due largely to its earlier approval than nintedanib in Japan.


Isshiki T, Sakamoto S, Yamasaki A, et al. Incidence of acute exacerbation of idiopathic pulmonary fibrosis in patients receiving antifibrotic agents: real-world experience. Published online July 26, 2021. Respir Med. doi:10.1016/j.rmed.2021.106551