Treating Patients with Idiopathic Pulmonary Fibrosis: Nintedanib or Pirfenidone?

In 2014, two new drugs, nintedanib (Ofev) and pirfenidone (Esbriet), were approved for idiopathic pulmonary fibrosis (IPF). Both medications slow progression of disease on pulmonary function tests, neither elevate patients' perceived quality of life, and both confer substantial side effects (nausea and rash with pirfenidone; diarrhea and abnormal liver function with nintedanib). No head-to-head comparison of the two agents has been done, so clinicians have little guidance about which to try first.

Using U.S. commercial insurance and Medicare data from 2014 to 2018, investigators compared 1255 nintedanib- or pirfenidone-treated IPF patients with 1255 propensity-matched but untreated IPF patients. Most patients were men; average age was 72. Ab…