PIRFENIDONE ADVERSE EVENT MANAGEMENT USING DOSE MODIFICATIONS IN PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS: RESULTS FROM AN ONLINE, SELF-ADMINISTERED SURVEY

Abstract

SESSION TITLE: IPF: From Diagnosis to Treatment SESSION TYPE: Original Investigations PRESENTED ON: 10/21/2019 01:30 pm - 02:30 pm PURPOSE: Pirfenidone is an approved treatment for idiopathic pulmonary fibrosis (IPF) that slows lung function decline. Although pirfenidone is generally well tolerated, some patients discontinue therapy due to adverse events (AEs). Temporary dose modifications may promote AE resolution and facilitate long-term treatment maintenance. To further understand which modification strategies may mitigate pirfenidone-related AEs in patients with IPF, a varied sample of US pulmonologists was surveyed. METHODS: An online, self-administered survey was fielded to pulmonologists between April 10 and May 17, 2017, by MedPanel, Inc. Pulmonologists were included if they spent >20% of their time in direct patient care and had ≥5 patients with IPF receiving antifibrotics. Pulmonologists answered questions about potential AE management in patients receiving pirfenidone maintenance therapy and rank ordered the steps they considered: temporary dose interruption, temporary dose reduction, prescribe/recommend additional agents, permanent discontinuation or unsure. Mean rankings were summarized by physician type (interstitial lung disease [ILD] specialists and community-based pulmonologists). RESULTS: A total of 169 pulmonologists responded; 69 (40.8%) and 100 (59.2%) were from ILD centers and community practices, respectively. Pulmonologists reported that a mean 58.6% (SD, 22.7%) of patients with IPF were receiving pirfenidone. For potential gastrointestinal (GI) AEs, such as nausea and vomiting, ILD pulmonologists ranked temporary dose reduction first followed by temporary dose interruption, prescribe/recommend additional agents and permanent discontinuation. Community pulmonologists also ranked temporary dose reduction first for potential GI AEs. For potential skin-related AEs, such as photosensitivity and rash, both groups ranked temporary dose interruption first before temporary dose reduction, followed by prescribe/recommend additional agents and permanent discontinuation of pirfenidone. Both ILD and community pulmonologist groups reported nearly half of patients (45% and 44%, respectively) achieved the maintenance dose of pirfenidone (2403 mg/d) after dose modification. Both pulmonologist groups had similar frequencies of patients discontinuing due to AEs, with the majority having CONCLUSIONS: Overall, pulmonologists typically use a temporary dose reduction first to manage pirfenidone-related GI AEs. For skin-related AEs, a temporary dose interruption is usually used first. Almost half of patients requiring dose modification can achieve the full maintenance dose of pirfenidone. CLINICAL IMPLICATIONS: Treatment persistence with pirfenidone can be maintained by effective dose-modification strategies. DISCLOSURES: Employee $100000 Added 03/14/2019 by Cindy Burg, source=Web Response, value=Salary Consultant relationship with Genentech, Inc. Please note: $1001 - $5000 Added 03/13/2019 by Tmirah Haselkorn, source=Web Response, value=Consulting fee Consultant relationship with Novartis Pharmaceuticals Corp. Please note: $1-$1000 Added 03/13/2019 by Tmirah Haselkorn, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Genentech, Inc. Please note: $1001 - $5000 Added 03/06/2019 by Peter LaCamera, source=Web Response, value=Consulting fee Consultant relationship with Genentech, Inc. Please note: $1001 - $5000 Added 03/06/2019 by Peter LaCamera, source=Web Response, value=Consulting fee Employee relationship with Roche Please note: >$100000 Added 03/14/2019 by John Stauffer, source=Web Response, value=Salary Employee $100000 Added 03/14/2019 by John Stauffer, source=Web Response, value=Ownership interest Speaker/Speaker's Bureau relationship with Genentech Please note: $1-$1000 Added 03/14/2019 by Mark Wencel, source=Web Response, value=Honoraria Employee relationship with Genentech, Inc. Please note: >$100000 Added 03/15/2019 by Ming Yang, source=Web Response, value=Salary