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Comparative Study
. 2021 Oct 19;22(1):268.
doi: 10.1186/s12931-021-01857-y.

Pirfenidone vs. nintedanib in patients with idiopathic pulmonary fibrosis: a retrospective cohort study

Pavo Marijic  1   2   3 , Larissa Schwarzkopf  4   5   6   7 , Lars Schwettmann  4   8 , Thomas Ruhnke  9 , Franziska Trudzinski  10 , Michael Kreuter  10
Affiliations
Comparative Study

Pirfenidone vs. nintedanib in patients with idiopathic pulmonary fibrosis: a retrospective cohort study

Pavo Marijic et al. Respir Res. .

Abstract

Background: Two antifibrotic drugs, pirfenidone and nintedanib, are licensed for the treatment of patients with idiopathic pulmonary fibrosis (IPF). However, there is neither evidence from prospective data nor a guideline recommendation, which drug should be preferred over the other. This study aimed to compare pirfenidone and nintedanib-treated patients regarding all-cause mortality, all-cause and respiratory-related hospitalizations, and overall as well as respiratory-related health care costs borne by the Statutory Health Insurance (SHI).

Methods: A retrospective cohort study with SHI data was performed, including IPF patients treated either with pirfenidone or nintedanib. Stabilized inverse probability of treatment weighting (IPTW) based on propensity scores was applied to adjust for observed covariates. Weighted Cox models were estimated to analyze mortality and hospitalization. Weighted cost differences with bootstrapped 95% confidence intervals (CI) were applied for cost analysis.

Results: We compared 840 patients treated with pirfenidone and 713 patients treated with nintedanib. Both groups were similar regarding two-year all-cause mortality (HR: 0.90 95% CI: 0.76; 1.07), one-year all cause (HR: 1.09, 95% CI: 0.95; 1.25) and respiratory-related hospitalization (HR: 0.89, 95% CI: 0.72; 1.08). No significant differences were observed regarding total (€- 807, 95% CI: €- 2977; €1220) and respiratory-related (€- 1282, 95% CI: €- 3423; €534) costs.

Conclusion: Our analyses suggest that the patient-related outcomes mortality, hospitalization, and costs do not differ between the two currently available antifibrotic drugs pirfenidone and nintedanib. Hence, the decision on treatment with pirfenidone versus treatment with nintedanib ought to be made case-by-case taking clinical characteristics, comorbidities, comedications, individual risk of side effects, and patients' preferences into account.

Keywords: Administrative data; Drugs; Health care costs; Hospitalization; Idiopathic pulmonary fibrosis; Mortality; Statutory health insurance.

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Conflict of interest statement

Michael Kreuter received grants and fees for consultation and speeches from Galapagos, Boehringer Ingelheim, and Roche either for himself or his institution. Larissa Schwarzkopf received fees for consultation from Galapagos. The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Participant flow of the study population
Fig. 2
Fig. 2
IPTW-weighted Kaplan–Meier plots for two-year all-cause mortality in patients treated with pirfenidone or nintedanib. The colored areas represent 95% confidence intervals
Fig. 3
Fig. 3
IPTW-weighted cumulative probability curves in patients treated with pirfenidone or nintedanib. a comparison of risk for all-cause hospitalization, b comparison of risk for respiratory-related hospitalization. The colored areas represent 95% confidence intervals
See this image and copyright information in PMC

References

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