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Semin Respir Crit Care Med 2016; 37(03): 368-377
DOI: 10.1055/s-0036-1582010
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Medical Therapy in Idiopathic Pulmonary Fibrosis

Katerina M. Antoniou
1   Department of Thoracic Medicine, Medical School, University of Crete, Crete, Greece
,
Wim Wuyts
2   Unit for Interstitial Lung Diseases, Department of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
,
Marlies Wijsenbeek
3   Department of Pulmonary Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
,
Athol U. Wells
4   Interstitial Lung Disease Unit, Royal Brompton Hospital, London, United Kingdom
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Publikationsdatum:
27. Mai 2016 (online)

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Abstract

Medical therapy for idiopathic fibrosis remains controversial. Idiopathic pulmonary fibrosis (IPF) was uniformly a disease that progressed inexorably, typically leading to death within 3 to 5 years from onset of symptoms. Until recently, lung transplantation was the only effective transplant option. Within the past decade, several placebo-controlled trials failed to show benefit in patients with IPF. However, within the past 2 years, two novel antifibrotic agents (pirfenidone and nintedanib) were approved by the Food and Drug Administration (FDA) in the United States and European Medicines Agency (EMA) based upon pivotal studies that showed benefit (specifically slowing of the rate of disease progression) with both agents. Short-term outcomes (12 months) showed less deterioration of physiological parameters (e.g., change in forced vital capacity), although survival benefit has not convincingly been established with either agent. Nonetheless, these agents bring a glimmer of hope to patients with this deadly disease. The appropriate indications for initiating therapy, best candidates for therapy, and possible role for combination therapy remain controversial. Additional studies using agents that attenuate or abrogate profibrotic cytokines and chemokines may provide even further improvement in the future.

Keywords

idiopathic pulmonary fibrosis - pirfenidone - nintedanib