Pirfenidone and Nintedanib were recommended for use in
idiopathic pulmonary fibrosis (IPF) with a moderate level of confidence, in a
guideline update from ATS/ERS/JRS/ALAT
It also mentions that the methods used by guideline panels to appraise
the evidence are different than those used by regulatory agencies like FDA when
they review applications seeking market approval for the use of pharmacologic
agents for treatment of IPF.
The guidline doesnot provide recommendations for one treatment
regimen over another. The guideline does not provide suggestions for or
against combination regimens or sequential therapies.
The updated
guidline has given strong recommendation against using prednisone with
azathioprine and N-acetylcysteine,The update also included strong
recommendations against use of warfarin or other anticoagulants due to
signals for harm in randomized trials in both cases. Both previously had been
suggested as not appropriate for most patients but perhaps reasonable for some.
Imatinib
and ambrisentan, not previously addressed in the guidelines, got strong
recommendations against use in IPF patients. Sildenafil is included in the
guidelines, and got a conditional recommendation against use.
The guidelines also updates on the dual endothelin receptor
antagonists macitentan and bosentan , it has changed from a strong to a
conditional recommendation against use.
The Lung transplantation which was not addressed in 2011 was also
included but formulation of recommendation for single vs bilateral lung
transplantation was deffered.
There is no change in the recommendation for anatacid therapy and
N acetyl cysteine monotherapy which remains as conditional recommendation for
use and conditional recommendation against use respectively.
Adverse effects were common with nintedanib therapy,
particularly diarrhea, although serious adverse events were not increased and
relatively few patients discontinued the drug due to adverse effects.
Pooled results from the pirfenidone trials showed more risk of
photosensitivity, fatigue, stomach discomfort, and anorexia with the drug.
I
have given the links to Download article from ATS.. Happy reading :)
1.http://www.atsjournals.org/doi/suppl/10.1164/rccm.201506-1063ST/suppl_file/executive_summary.pdf
2.http://www.atsjournals.org/doi/suppl/10.1164/rccm.201506-1063ST/suppl_file/raghu_data_supplement.pdf
3.http://www.atsjournals.org/doi/suppl/10.1164/rccm.201506-1063ST/suppl_file/raghu_data_supplement+2.pdf
