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Antacid therapy and disease progression in patients with idiopathic pulmonary fibrosis who received pirfenidone

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Title: Antacid therapy and disease progression in patients with idiopathic pulmonary fibrosis who received pirfenidone
Authors: Kreuter, M
Spagnolo, P
Wuyts, W
Renzoni, E
Koschel, D
Bonella, F
Maher, TM
Kolb, M
Weycker, D
Kirchgassler, K-U
Costabel, U
Item Type: Journal Article
Abstract: Background: Gastroesophageal reflux disease is a potential risk factor for idiopathic pulmonary fibrosis (IPF) progression; however, the impact of antacid therapy (AAT) is under debate. Objective: To evaluate the effect of AAT on IPF progression in pirfenidone-treated patients. Methods: This post hoc analysis included patients with IPF who received pirfenidone in 3 trials (CAPACITY [PIPF-004/PIPF-006] and ASCEND [PIPF-016]). Pulmonary function, exercise tolerance, survival, hospitalizations, and adverse events (AEs) over 52 weeks were analyzed by baseline AAT use. Disease progression was defined as a decrease in forced vital capacity (FVC) of ≥10%, a decrease in 6-min walking distance of ≥50 m, or death over 1 year. Results: Of 623 patients, 44% received AAT. No significant differences were found at 52 weeks (AAT versus non-AAT, respectively) in disease progression (24.9 vs. 30.6%; p = 0.12), all-cause mortality rate (2.9 vs. 4.0%; p = 0.47), IPF-related mortality rate (1.1 vs. 2.0%; p = 0.37), all-cause hospitalization rate (16.1 vs. 18.3%; p = 0.48), or mean change in percent FVC (-2.7 vs. -3.1%; p = 0.44). A relative, but not absolute, FVC decline of ≥10% favored AAT (15 vs. 22%; p = 0.03). Severe gastrointestinal AEs (3.7 vs. 0.9%; p = 0.015) and severe pulmonary infections (3.7 vs. 1.1%; p = 0.035) were more frequent with AAT. Conclusions: AAT and pirfenidone had outcomes comparable to those of pirfenidone alone in patients with IPF, underscoring the need for prospective trials to elucidate the role of AAT with or without antifibrotic drugs as a treatment for IPF.
Issue Date: 12-Apr-2017
Date of Acceptance: 6-Mar-2017
URI: http://hdl.handle.net/10044/1/49921
DOI: https://dx.doi.org/10.1159/000468546
ISSN: 1423-0356
Publisher: Karger Publishers
Start Page: 415
End Page: 423
Journal / Book Title: Respiration
Volume: 93
Issue: 6
Copyright Statement: © 2017 The Author(s) Published by S. Karger AG, Basel. Th is article is licensed under the Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License (CC BY- NC-ND) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes as well as any dis- tribution of modifi ed material requires written permission.
Sponsor/Funder: Raynaud's and Scleroderma Association
Funder's Grant Number: BR11
Keywords: Science & Technology
Life Sciences & Biomedicine
Respiratory System
Antacid therapy
Gastroesophageal reflux disease
Idiopathic pulmonary fibrosis
Progression-free survival
1102 Cardiovascular Medicine And Haematology
Publication Status: Published
Appears in Collections:National Heart and Lung Institute