Predictors of the clinical effects of pirfenidone on idiopathic pulmonary fibrosis

Respir Investig. 2014 Mar;52(2):136-43. doi: 10.1016/j.resinv.2013.09.002. Epub 2013 Oct 24.


Background: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease with a poor prognosis. Recently, pirfenidone was reported to slow the rate of decline in vital capacity and improve progression-free survival in IPF. The purpose of this study was to clarify the factors that predicted a good response to pirfenidone, as well as its adverse effects.

Methods: Forty-one IPF cases, treated with pirfenidone from January 2009 to January 2011, were enrolled in this investigation. Disease severity was classified into grades I-IV, as defined by the Japanese Respiratory Society (JRS). Short-term responsiveness to pirfenidone was evaluated by the modified criteria of the JRS. Predictors of nausea, anorexia, or both that represented important adverse effects were examined by multivariate Cox proportional hazard analyses. Predictors of short-time responsiveness were examined by multivariate logistic regression analyses.

Results: Diagnosed by a surgical lung biopsy (SLB), the mild cases of grade I/II were predictors of good, short-term responsiveness. Patients taking acid-secretion inhibitors, including proton pump inhibitors and histamine H2-receptor antagonists, showed less anorexia, nausea, or both. Only 1 case was administered drugs to activate gastrointestinal motility.

Conclusions: We concluded that IPF patients with a mild disease, diagnosis by SLB, or both showed indications of a good response to pirfenidone. In addition, acid-secretion inhibitors may reduce the frequency of anorexia, nausea, or both from pirfenidone.

Keywords: Acid-secretion inhibitors; Anorexia; Idiopathic pulmonary fibrosis; Pirfenidone.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anorexia / chemically induced
  • Anorexia / prevention & control
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Female
  • Histamine H2 Antagonists / administration & dosage
  • Humans
  • Idiopathic Pulmonary Fibrosis / diagnosis
  • Idiopathic Pulmonary Fibrosis / drug therapy*
  • Idiopathic Pulmonary Fibrosis / mortality
  • Idiopathic Pulmonary Fibrosis / physiopathology
  • Logistic Models
  • Male
  • Middle Aged
  • Nausea / chemically induced
  • Nausea / prevention & control
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Proton Pump Inhibitors / administration & dosage
  • Pyridones / adverse effects
  • Pyridones / therapeutic use*
  • Retrospective Studies
  • Severity of Illness Index
  • Survival Rate
  • Time Factors
  • Treatment Outcome
  • Vital Capacity


  • Anti-Inflammatory Agents, Non-Steroidal
  • Histamine H2 Antagonists
  • Proton Pump Inhibitors
  • Pyridones
  • pirfenidone