Switching to nintedanib after discontinuation of pirfenidone due to adverse events in IPF

Rationale: The IPF treatments pirfenidone and nintedanib have overlapping adverse effect profiles with gastrointestinal disorders among the most frequent reasons for drug discontinuation. Further, intraindividual response to pirfenidone treatment varies. It is unknown whether nintedanib can be tolerated and efficacious in patients displaying intolerability or inefficacy of pirfenidone treatment.

Objectives: To assess tolerability and efficacy of nintedanib in patients discontinuing pirfenidone due to adverse events.

Methods: Retrospective analysis of all patients from the Comprehensive Pneumology Center, University of Munich included in the nintedanib Compassionate Use Program and previously treated with pirfenidone, by assessment of lung physiological features, laboratory tests and questionnaire.

Main Results: Out of seven patients included, five had not tolerated pirfenidone, with asthenia being the most frequent reason for discontinuation (4/5). All but one of these displayed better tolerability of nintedanib. Regarding treatment response, two previously progressive patients stabilized under nintedanib, one remained stable as before switching, and one patient previously stable under pirfenidone showed progressive disease under nintedanib. Two patients had switched treatment due to rapid progression, and continued to progress under nintedanib.

Conclusions: Nintedanib can be well-tolerated in patients who stopped pirfenidone treatment due to intolerable adverse effects. Intraindividual response to the two drugs may differ.