Safety and efficacy of bridging to lung transplantation with antifibrotic drugs in idiopathic pulmonary fibrosis: a case series.

Abstract

BACKGROUND:

Following recent approval of pirfenidone and nintedanib for idiopathic pulmonary fibrosis (IPF), questions arise about the use of these antifibrotics in patients awaiting lung transplantation (LTx).

METHODS:

Safety and efficacy of antifibrotic drugs in IPF patients undergoing LTx were investigated in a single-centre retrospective cohort analysis.

RESULTS:

A total of nine patients, receiving antifibrotic therapy for 419 ± 315 days until subsequent LTx, were included. No major side effects were noted. Significant weight loss occurred during antifibrotic treatment (p = 0.0062). FVC tended to stabilize after 12 weeks of treatment in most patients. A moderate decline in FVC, TLC and DLCO was noted during the whole pretransplant time period of antifibrotic therapy. Functional exercise capacity and lung allocation score remained unchanged. No post-operative thoracic wound healing problems, nor severe early anastomotic airway complications were attributable to prior antifibrotic treatment. None of the patients developed chronic lung allograft dysfunction after a median follow-up of 19.8 (11.2-26.5) months; and post-transplant survival was 100% after 1 year and 80% after 2 years.

CONCLUSIONS:

Antifibrotic drugs can probably be safely administered in IPF patients, possibly attenuating disease progression over time, while awaiting LTx.

• Authors: Isabelle Delanote, Wim A Wuyts, Jonas Yserbyt, Eric K Verbeken, Geert M Verleden, Robin Vos
• Journal: BMC pulmonary medicine (BMC Pulm Med) Vol. 16 Issue 1 Pg. 156 (11 18 2016) ISSN: 1471-2466 [Electronic] England
• PMID: 27863518 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Indoles
• Pyridones
• pirfenidone
• nintedanib

Topics

• Aged
• Anti-Inflammatory Agents, Non-Steroidal (adverse effects, therapeutic use)
• Belgium
• Disease Progression
• Female
• Graft Survival
• Humans
• Idiopathic Pulmonary Fibrosis (therapy)
• Indoles (adverse effects, therapeutic use)
• Lung (physiopathology)
• Lung Transplantation
• Male
• Middle Aged
• Postoperative Complications (epidemiology)
• Pyridones (adverse effects, therapeutic use)
• Retrospective Studies
• Tertiary Care Centers
• Vital Capacity