Cited by 121Interstitial Lung Diseases and Idiopathic Pulmonary FibrosisPharmacovigilance and Adverse Drug ReactionsAtrial Fibrillation Management and Outcomes

Long-term safety of pirfenidone: results of the prospective, observational PASSPORT study

Open access
Cottin, Vincent, Koschel, Dirk, Günther, Andreas, Albera, Carlo, Azuma, Arata, Sköld, C. Magnus, Tomassetti, Sara, Hormel, Philip +4 more·2018·ERJ Open Research

Abstract

Real-world studies include a broader patient population for a longer duration than randomised controlled trials (RCTs) and can provide relevant insights for clinical practice. PASSPORT was a multicentre, prospective, post-authorisation study of patients who were newly prescribed pirfenidone and followed for 2 years after initiating treatment. Physicians collected data on adverse drug reactions (ADRs), serious ADRs (SADRs) and ADRs of special interest (ADRSI) at baseline and then every 3 months.Post hocstepwise logistic regression models were used to identify baseline characteristics associated with discontinuing treatment due to an ADR. Patients (n=1009, 99.7% with idiopathic pulmonary fibrosis) had a median pirfenidone exposure of 442.0 days. Overall, 741 (73.4%) patients experienced ADRs, most commonly nausea (20.6%) and fatigue (18.5%). ADRs led to treatment discontinuation in 290 (28.7%) patients after a median of 99.5 days. Overall, 55 (5.5%) patients experienced SADRs, with a fatal outcome in six patients. ADRSI were reported in 693 patients, most commonly gastrointestinal symptoms (38.3%) and photosensitivity reactions/skin rashes (29.0%). Older age and female sex were associated with early treatment discontinuation due to an ADR. Findings were consistent with the known safety profile of pirfenidone, based on RCT data and other post-marketing experience, with no new safety signals observed.

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Registry

Crossref · 10.1183/23120541.00084-2018

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  • The limited efficacy and tolerability challenges of pirfenidone and nintedanib contribute to low treatment uptake, frequent discontinuation, and impaired quality of life.

    “Their limited efficacy, combined with tolerability challenges, contributes to low treatment uptake, frequent discontinuation of both treatments, and impaired quality of life.6-8”

    From Deupirfenidone Compared with Pirfenidone and Placebo in Idiopathic Pulmonary Fibrosis (ELEVATE-IPF): a Phase 2b Randomized Placebo-Controlled Trial (2026) · cites this paper as [6]

    The Discussion reports that adverse drug reactions led to pirfenidone discontinuation in approximately 29% of PASSPORT patients, supporting the tolerability and discontinuation portion of the claim for pirfenidone. The study did not assess nintedanib or treatment uptake, and the Discussion states that efficacy data were not collected; it also provides no evidence that these factors impaired quality of life. (LLM, conf=0.90)

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  • Both pirfenidone and nintedanib are associated with adverse effects that limit treatment duration.

    “however, neither drug halts disease progression, and both are associated with adverse effects that limit treatment duration (4, 5).”
  • Gastrointestinal adverse effects of current antifibrotic therapies can limit treatment persistence and/or require dose adjustments.

    “which can limit treatment persistence and/or require dose adjustments (4, 5).”
  • Neither pirfenidone nor nintedanib halts disease progression in IPF.

    “however, neither drug halts disease progression, and both are associated with adverse effects that limit treatment duration (4, 5).”

    From Efficacy and Safety of Admilparant, an LPA1 Antagonist, in Pulmonary Fibrosis: A Phase 2 Randomized Clinical Trial. (2025) · cites this paper as [4]

    The Introduction describes IPF as progressive, but does not say whether pirfenidone or nintedanib halts its progression. The Discussion states that PASSPORT collected no efficacy data, such as lung function or exercise capacity. Searches for disease progression and nintedanib found no passage addressing the claim. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 2

  1. [5]Pharmaceuticals and Medical Devices Agency Japan. Pirfenidone Review Report 2008 www.pmda.go.jp/files/000153687.pdf Date last accessed: June 4, 2018.
  2. [18]Lancaster LH, Morrison LD, Auais A, et al. Pirfenidone in patients aged 80 years and older with idiopathic pulmonary fibrosis (IPF): safety findings from pooled trial databases. Am J Respir Crit Care Med 2017; 195: A5385.

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Authors
Cottin, V., Koschel, D., Günther, A., Albera, C., Azuma, A., Sköld, C. M., Tomassetti, S., Hormel, P., Stauffer, J. L., Strombom, I., Kirchgaessler, K.-U., & Maher, T. M.
Affiliations
  • Lyon 1 Université (FR)
  • Universitätsklinikum Gießen und Marburg (DE)
  • University of Turin (IT)
  • Nippon Medical School (JP)
  • Karolinska University Hospital (SE)
  • Ospedale G.B. Morgagni - L.Pierantoni (IT)
  • Genentech (US)
  • F. Hoffmann-La Roche AG (CH)
  • Royal Brompton Hospital (GB)
Venue
ERJ Open Research
Published
2018-10
Volume
4
Issue
4
Pages
00084-2018
ISSN
2312-0541 (ISSN-L)
OpenAlex
W2897924093
Cited by
121
References
14
Citations by year
2026: 8 · 2025: 13 · 2024: 18 · 2023: 11 · 2022: 15 · 2021: 19 · 2020: 21 · 2019: 15 · 2018: 1
FWCI
10.55
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • ERJ Open Research (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Florence Research (University of Florence) (submittedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion, other-oa)
Funders
F Hoffmann-La Roche, Ltd.
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
Keywords
pirfenidone, idiopathic pulmonary fibrosis, drug safety, adverse drug reactions, serious adverse drug reactions, treatment discontinuation, photosensitivity reactions, nausea, fatigue

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