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Cited by 337Interstitial Lung Diseases and Idiopathic Pulmonary FibrosisChronic Obstructive Pulmonary Disease (COPD) ResearchOccupational and environmental lung diseases

Effect of pirfenidone on mortality: pooled analyses and meta-analyses of clinical trials in idiopathic pulmonary fibrosis

Nathan, Steven D, Albera, Carlo, Bradford, Williamson Z, Costabel, Ulrich, Glaspole, Ian, Glassberg, Marilyn K, Kardatzke, David R, Daigl, Monica +7 more·2017·The Lancet Respiratory Medicine
DOI 10.1016/s2213-2600(16)30326-5
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Abstract

Background In clinical trials of idiopathic pulmonary fibrosis, rates of all-cause mortality are low. Thus prospective mortality trials are logistically very challenging, justifying the use of pooled analyses or meta-analyses. We did pooled analyses and meta-analyses of clinical trials of pirfenidone versus placebo to determine the effect of pirfenidone on mortality outcomes over 120 weeks.Methods We did a pooled analysis of the combined patient populations of the three global randomised phase 3 trials of pirfenidone versus placebo-Clinical Studies Assessing Pirfenidone in Idiopathic Pulmonary Fibrosis: Research of Efficacy and Safety Outcomes (CAPACITY 004 and 006; trial durations 72-120 weeks) and Assessment of Pirfenidone to Confirm Efficacy and Safety in Idiopathic Pulmonary Fibrosis (ASCEND 016; 52 weeks)-for all-cause mortality, treatment-emergent all-cause mortality, idiopathic-pulmonary-fibrosis-related mortality, and treatment-emergent idiopathic-pulmonary-fibrosis-related mortality at weeks 52, 72, and 120. We also did meta-analyses of these data and data from two Japanese trials of pirfenidone versus placebo-Shionogi Phase 2 (SP2) and Shionogi Phase 3 (SP3; trial durations 36-52 weeks).Findings At week 52, the relative risk of death for all four mortality outcomes was significantly lower in the pirfenidone group than in the placebo group in the pooled population (all-cause mortality hazard ratio [HR] 0·52 [95% CI 0·31-0·87; p=0·0107]; treatment-emergent all-cause mortality 0·45 [0·24-0·83; 0·0094]; idiopathic-pulmonary-fibrosis-related mortality 0·35 [0·17-0·72; 0·0029]; treatment-emergent idiopathic-pulmonary-fibrosis-related mortality 0·32 [0·14-0·76; 0·0061]). Consistent with the pooled analysis, meta-analyses for all-cause mortality at week 52 also showed a clinically relevant and significant risk reduction in the pirfenidone group compared with the placebo group. Over 120 weeks, we noted significant differences in the pooled analysis favouring pirfenidone therapy compared with placebo for treatment-emergent all-cause mortality (p=0·0420), idiopathic-pulmonary-fibrosis-related mortality (0·0237), and treatment-emergent idiopathic-pulmonary-fibrosis-related (0·0132) mortality; similar results were shown by meta-analyses.Interpretation Several analytic approaches demonstrated that pirfenidone therapy is associated with a reduction in the relative risk of mortality compared with placebo over 120 weeks.Funding F Hoffmann-La Roche/Genentech.

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Authors
Nathan, S. D., Albera, C., Bradford, W. Z., Costabel, U., Glaspole, I., Glassberg, M. K., Kardatzke, D. R., Daigl, M., Kirchgaessler, K.-U., Lancaster, L. H., Lederer, D. J., Pereira, C. A., Swigris, J. J., Valeyre, D., & Noble, P. W.
Affiliations
  • Inova Fairfax Hospital (US)
  • University of Turin (IT)
  • Ruhrlandklinik (DE)
  • The Alfred Hospital (AU)
  • University of Miami (US)
  • Genentech (US)
  • F. Hoffmann-La Roche AG (CH)
  • Vanderbilt University Medical Center (US)
  • Columbia University Irving Medical Center (US)
  • Universidade Federal de São Paulo (BR)
  • National Jewish Health (US)
  • Assistance Publique – Hôpitaux de Paris (FR)
  • Cedars-Sinai Medical Center (US)
Corresponding author
Nathan, Steven D
ORCID
Venue
The Lancet Respiratory Medicine
Publisher
Elsevier BV
Published
2017-01
Volume
5
Issue
1
Pages
33-41
ISSN
2213-2600 (ISSN-L)
DOI
10.1016/s2213-2600(16)30326-5
OpenAlex
W2550523848
Cited by
335
References
20
Citations by year
2026: 19 · 2025: 29 · 2024: 28 · 2023: 34 · 2022: 31 · 2021: 34 · 2020: 45 · 2019: 44 · 2018: 39 · 2017: 28 · 2016: 2 · 2013: 1
FWCI
33.70
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet Respiratory Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
  • UNIFESP Institutional Repository (Universidade Federal de São Paulo) (submittedVersion)
Funders
  • FibroGen
  • National Institutes of Health
  • Genentech
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Occupational and environmental lung diseases
Keywords
pirfenidone, idiopathic pulmonary fibrosis, all-cause mortality, mortality reduction, antifibrotic therapy, CAPACITY trial, ASCEND trial, pooled analysis, placebo comparison, mortality hazard ratio, treatment-emergent adverse events
MeSH terms
Anti-Inflammatory Agents, Non-Steroidal, Cause of Death, Humans, Pyridones, Vital Capacity, Randomized Controlled Trials as Topic, Treatment Outcome, Clinical Trials, Phase III as Topic, Idiopathic Pulmonary Fibrosis

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