Abstract
BackgroundTwo antifibrotic drugs, pirfenidone and nintedanib, are licensed for the treatment of patients with idiopathic pulmonary fibrosis (IPF). However, there is neither evidence from prospective data nor a guideline recommendation, which drug should be preferred over the other. This study aimed to compare pirfenidone and nintedanib-treated patients regarding all-cause mortality, all-cause and respiratory-related hospitalizations, and overall as well as respiratory-related health care costs borne by the Statutory Health Insurance (SHI).MethodsA retrospective cohort study with SHI data was performed, including IPF patients treated either with pirfenidone or nintedanib. Stabilized inverse probability of treatment weighting (IPTW) based on propensity scores was applied to adjust for observed covariates. Weighted Cox models were estimated to analyze mortality and hospitalization. Weighted cost differences with bootstrapped 95% confidence intervals (CI) were applied for cost analysis.ResultsWe compared 840 patients treated with pirfenidone and 713 patients treated with nintedanib. Both groups were similar regarding two-year all-cause mortality (HR: 0.90 95% CI: 0.76; 1.07), one-year all cause (HR: 1.09, 95% CI: 0.95; 1.25) and respiratory-related hospitalization (HR: 0.89, 95% CI: 0.72; 1.08). No significant differences were observed regarding total (€− 807, 95% CI: €− 2977; €1220) and respiratory-related (€− 1282, 95% CI: €− 3423; €534) costs.ConclusionOur analyses suggest that the patient-related outcomes mortality, hospitalization, and costs do not differ between the two currently available antifibrotic drugs pirfenidone and nintedanib. Hence, the decision on treatment with pirfenidone versus treatment with nintedanib ought to be made case-by-case taking clinical characteristics, comorbidities, comedications, individual risk of side effects, and patients’ preferences into account.
Highlights
Two antifibrotic drugs, pirfenidone and nintedanib, are licensed for the treatment of patients with idiopathic pulmonary fibrosis (IPF)
A claims data-based study among Medicare enrollees suggested that pirfenidone treatment is associated with fewer all-cause and fewer respiratory-related hospitalizations and lower inpatient costs compared to nintedanib treatment [15]
Population characteristics We identified 2524 patients with an IPF diagnosis who received an antifibrotic therapy with nintedanib or pirfenidone between January 1, 2013 and December 31, 2018
Summary
Pirfenidone and nintedanib, are licensed for the treatment of patients with idiopathic pulmonary fibrosis (IPF). In Germany, pirfenidone was approved in 2012 and Marijic et al Respir Res (2021) 22:268 nintedanib in 2015 Both drugs have been shown to slow IPF progression [3, 4], to increase survival [5,6,7] and to reduce respiratory-related hospitalizations [8]. A claims data-based study among Medicare enrollees suggested that pirfenidone treatment is associated with fewer all-cause and fewer respiratory-related hospitalizations and lower inpatient costs compared to nintedanib treatment [15]. A recently published study with data from the French National Health System [13] reported an association between pirfenidone treatment and lower respiratory-related hospitalizations.
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