Pirfenidone Treatment in Individuals with Idiopathic Pulmonary Fibrosis: Impact of Timing of Treatment Initiation

Idiopathic pulmonary fibrosis (IPF) is a debilitating, progressive, fatal, fibrosing lung disease (1, 2).Pirfenidone and nintedanib are oral antifibrotics with demonstrated efficacy in reducing lung function decline in individuals with IPF, independent of baseline lung function (3-7).Intervention with an antifibrotic as early as possible in the disease course might be the most appropriate strategy to preserve lung capacity (5).However, many physicians are reluctant to initiate antifibrotics at diagnosis, and delay treatment until disease progression is observed (8).Furthermore, certain countries do not reimburse antifibrotic treatment for individuals with preserved lung function (% predicted forced vital capacity [FVC] .80%) (8).These post hoc analyses aimed to assess: 1) FVC decline during long-term pirfenidone treatment in RECAP in individuals with IPF categorized by baseline % predicted FVC; and 2) the impact of deferring pirfenidone treatment on annual FVC decline in individuals with IPF during CAPACITY (3) and RECAP (9).Methods RECAP (NCT00662038) was an open-label extension study, including individuals who had completed the double-blind, placebo-controlled trials of pirfenidone in individuals with IPF (ASCEND [Assessment of Pirfenidone to Confirm Efficacy and Safety in Idiopathic Pulmonary Fibrosis] [NCT01366209]; CAPACITY [Clinical Studies Assessing Pirfenidone in Idiopathic Pulmonary Fibrosis: Research of Efficacy and Safety Outcomes] [NCT00287716/NCT00287729]); the methods and primary