The DOI matches its Crossref record; 33 of the 33 references it cites were found in a registry or an index.
Adoption of the Antifibrotic Medications Pirfenidone and Nintedanib for Patients with Idiopathic Pulmonary Fibrosis
Abstract
Abstract Rationale In October 2014, the antifibrotic medications pirfenidone and nintedanib became the first medications approved by the U.S. Food and Drug Administration for use in patients with idiopathic pulmonary fibrosis (IPF). Since approval, there has been no nonregistry analysis of the real-world adoption of these medications in everyday clinical practice. Objectives To evaluate the adoption, persistence, and out-of-pocket (OOP) costs of pirfenidone and nintedanib since their approval in the United States in 2014. Methods A retrospective cohort analysis was performed by identifying privately insured and Medicare Advantage beneficiaries with IPF. We then split the patients into three cohorts: those who were untreated and those who filled a prescription for either pirfenidone or nintedanib between October 1, 2014, and July 31, 2019. The primary outcome was adoption of the medications. Secondary outcomes included medication persistence and prescription drug costs. Results A total of 10,996 patients with IPF were identified in the data set. A minority of patients (26.4%) with IPF identified in the cohort had started either medication since approval in 2014, with the adoption of both medications being comparable at around 13.2%. Those receiving the medications were younger (72 vs. 73.9 yr; P < 0.0001) and healthier (3.9 vs. 4.9 comorbidities; P < 0.0001) than those not receiving treatment. Men were significantly more likely to receive treatment than woman (30.0% vs. 21.9%; P < 0.0001). Among treated patients, 42.8% discontinued the medications during the study period. Patients’ OOP expenses per month were high for both drugs (mean, $397.51 for nintedanib; mean, $394.49 for pirfenidone). Conclusions The adoption of both the antifibrotic medications in the United States in everyday practice has been low since approval and may be associated with the high OOP cost.
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“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 [7]
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Cites
Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data
Quan, H., Sundararajan, V., Halfon, P., Fong, A., Burnand, B., Luthi, J.-C., Saunders, L. D., Beck, C. A., Feasby, T. E., & Ghali, W. A. (2005) · Medical Care · doi:10.1097/01.mlr.0000182534.19832.83 · Cited by 10,669
Efficacy and Safety of Nintedanib in Idiopathic Pulmonary Fibrosis
Richeldi, L., du Bois, R. M., Raghu, G., Azuma, A., Brown, K. K., Costabel, U., Cottin, V., Flaherty, K. R., Hansell, D. M., Inoue, Y., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1402584 · Cited by 4,654
A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis.
King, T. E., Bradford, W. Z., Castro-Bernardini, S., Fagan, E. A., Glaspole, I., Glassberg, M. K., Gorina, E., Hopkins, P. M., Kardatzke, D., Lancaster, L., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1402582 · Cited by 3,975
Medication compliance and persistence: terminology and definitions
Cramer, J. A., Roy, A., Burrell, A., Fairchild, C. J., Fuldeore, M. J., Ollendorf, D. A., & Wong, P. K. (2008) · Value in Health · doi:10.1111/j.1524-4733.2007.00213.x · Cited by 2,220
Raghu, G., Rochwerg, B., Zhang, Y., Garcia, C. A. C., Azuma, A., Behr, J., Brozek, J. L., Collard, H. R., Cunningham, W., Homma, S., et al. (2015) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201506-1063st · Cited by 1,916
Prednisone, Azathioprine, and N -Acetylcysteine for Pulmonary Fibrosis
The Idiopathic Pulmonary Fibrosis Clinical Research Network (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1113354 · Cited by 1,654
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Idiopathic Interstitial Pneumonia
Flaherty, K. R., King, T. E., Raghu, G., Lynch, J. P., Colby, T. V., Travis, W. D., Gross, B. H., Kazerooni, E. A., Toews, G. B., Long, Q., et al. (2004) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200402-147oc · Cited by 672
Treatment of Idiopathic Pulmonary Fibrosis With Ambrisentan: A Parallel, Randomized Trial
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Research works printed but not linked: 4
- Flaherty, 2018, Baseline characteristics of 1461 participants in the pulmonary fibrosis foundation patient registry [abstract], Eur Respir J, 52, PA2199
- Wong, 2018, Direct oral anticoagulant prescription trends, switching patterns, and adherence in Texas Medicaid, Am J Manag Care, 24, SP309
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Items 101–101 of 101
Sheffield, B. A., Cassel, B. J., Perelas, A., Sime, P., & Jackson, P. (2026) · PLoS ONE · doi:10.1371/journal.pone.0360987
Metadata
- Authors
- Dempsey, T. M., Payne, S., Sangaralingham, L., Yao, X., Shah, N. D., & Limper, A. H.
- Affiliations
- Department of Pulmonary and Critical Care Medicine
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
- Mayo Clinic (US)
- Corresponding author
- Dempsey, Timothy M.
- ORCID
- Venue
- Annals of the American Thoracic Society
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-07-01
- Volume
- 18
- Issue
- 7
- Pages
- 1121-1128
- ISSN
- 2325-6621 (ISSN-L)
- 2329-6933
- OpenAlex
- W3122584685
- Cited by
- 101
- References
- 33
- Citations by year
- 2026: 24 · 2025: 21 · 2024: 22 · 2023: 14 · 2022: 11 · 2021: 9
- FWCI
- 9.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of the American Thoracic Society (publishedVersion)
- PubMed (publishedVersion)
- 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
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
- Keywords
- idiopathic pulmonary fibrosis, pirfenidone, nintedanib, antifibrotic agents, treatment persistence, out-of-pocket costs, prescription drug costs, Medicare Advantage beneficiaries, real-world applications, drug approval
- MeSH terms
- Aged, Pharmaceutical Preparations, Female, Medicare, Humans, Indoles, Male, Pyridones, Retrospective Studies, United States, Treatment Outcome, Idiopathic Pulmonary Fibrosis
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