| Popis: |
Background: The National Institute for Health and Care Excellence (NICE) approved pirfenidone (PIR) in England & Wales for IPF in April 2013. Nintedanib (NIN) became available more recently on a named patient basis. We review our experience with both agents. Methods: Patients in the ILD clinic at Hammersmith Hospital with IPF diagnosed according to ATS/ERS 1 and NICE 2 guidelines were offered therapy in line with national guidance and availability. From Apr 2013, those with FVC 50-80% predicted received (PIR). In Jul-Dec 2014, PIR was available for mild disease. From Jan 2015 NIN was available on a named patient basis; in Jun 2015 it was restricted to those not eligible for PIR. Results: By 1 Feb 2016, 36 patients had been treated (86% male; mean age 73 yrs; 12 PIR; 24 NIN; 3 switched to NIN because of side-effects). At initial review, 44% had an FVC outside NICE criteria for treatment. 58% of those on PIR tolerated the maximum dose (2403 mg/day), but 58% noted side-effects. 42% of patients remained on PIR on 1 Feb 2016 (mean treatment duration 8 months). 88% of those on NIN tolerated the maximum dose (400 mg/day); 50% noted side-effects. 88% of patients remained on NIN on 1 Feb 2016 (mean treatment duration 7 months). Those who switched to NIN expressed a strong preference for it. Conclusions: Our experience of anti-fibrotics in IPF gives real world information on safety, tolerability and patient perceptions, further informing physicians and patients about their options. Nintedanib may be better tolerated than pirfenidone. Significant numbers of IPF patients are not eligible for anti-fibrotic therapy under NICE guidance. 1. ATS/ERS/JRS/ALAT Clinical Practice Guideline Jul 2015 2. Guideline CG 163 Jun 2013 www.nice.org.uk/guidance/cg163. |
