Switching antifibrotic drugs could improve the treatment of patients with idiopathic pulmonary fibrosis (IPF) who develop intolerable adverse effects or show disease progression after first-line antifibrotic treatment, according to a multicenter study conducted in Turkey.

The authors of the study recently published in the journal Pulmonary Pharmacology & Therapeutics showed that forced vital capacity (FVC) was maintained in 30.3% of patients after 12 months of the first-line antifibrotic treatment (before switching treatments), as well as in 40% of patients at 12 months after the switch.

They also found that 42.4% of patients who received antifibrotic treatment before the switch presented with a decline in FVC of more than 10% at the end of 12 months. Moreover, 32.0% of patients had a decline in FVC of 10% or higher 12 months after switching treatments.

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“In real-life clinical practice, switching antifibrotics is not uncommon, but limited data is available about the effectiveness and safety profile of this management strategy,” the authors said.

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Disease progression (56%) and development of severe adverse effects (SAEs, 44%) were the most common motivations for switching treatments. There was a significant reduction in the SAEs observed after the switch when compared to those reported before the switch (43.9% vs 12.1%, respectively, P <.001).

Out of the 18 patients who developed adverse effects due to second-line antifibrotics, 8 had SAEs and 10 complained of mild adverse effects.

In Cilli et al’s study cohort, 10.5% of patients (n=66, mean age, 70.6 ± 8.9 years, 71.2% male) switched antifibrotics. Most (84.8%) were receiving pirfenidone as a first-line antifibrotic agent.

Nintedanib and pirfenidone are two medications working on slowing disease progression and have a mortality benefit in IPF,” the authors explained. “However, both can have substantial adverse effects leading to discontinuation of treatment in approximately 15% of the patients with pirfenidone and 19% with nintedanib treatment within studies.”

The median duration of the antifibrotic treatment prior to the switch was 13 (1-41) months, while after the switch it was 14 (2–42) months.


Cilli A, Uzer F, Sevinç C, et al. Tolerability and efficacy of second-line antifibrotics in patients with idiopathic pulmonary fibrosis. Pulm Pharmacol Ther. Published online November 15, 2021. doi:10.1016/j.pupt.2021.102099