Konishi Satoshi, Arita Machiko, Ito Isao, Tachibana Hiromasa, Takaiwa Takuya, Fukuda Yasushi, Watanabe Naoki, Tsubouchi Kazuya, Masuda Gen, Tanaka Maki, Kourogi Youhei, Kunimasa Kei, Nishiyama Akihiro, Iwasaku Masahiro, Ito Akihiro, Tokioka Fumiaki, Yoshioka Hiroshige, Hashimoto Toru, Ishida Tadashi
Department of Respiratory Medicine, Kurashiki Central Hospital, Japan.
Intern Med. 2015;54(22):2835-41. doi: 10.2169/internalmedicine.54.4118. Epub 2015 Nov 15.
The goals of this study were to assess the efficacy and tolerability of pirfenidone in patients with idiopathic pulmonary fibrosis (IPF) and to identify predictors of tolerability to pirfenidone.
We conducted a retrospective observational study. When the patient showed deterioration in the percent forced vital capacity (%FVC) or experienced acute exacerbations or severe adverse events, treatment of the patient with pirfenidone was discontinued. We classified the patients who did not display progression following six months of pirfenidone treatment as the tolerant group and the patients who did display progression as the intolerant group. We retrospectively analyzed differences between the two groups in terms of baseline characteristics. The efficacy of pirfenidone was evaluated by the changes in vital capacity (VC) and %FVC before and after the start of treatment in the tolerant group. Patients A total of 20 patients who had been diagnosed with IPF were treated with pirfenidone.
In the tolerant group, the baseline %FVC (p=0.01) and the percentage diffusing capacity of the lungs for carbon monoxide (DLCO, p=0.02) were significantly higher, and the baseline composite physiologic index (CPI) was significantly lower (p=0.009) than in the intolerant group. In the tolerant group, pirfenidone significantly reduced the decline in VC and %FVC of the patients after treatment. In the intolerant group, five patients discontinued pirfenidone treatment because of anorexia.
We found that pirfenidone was better tolerated in patients with milder disease symptoms, as indicated by their baseline CPI, %FVC and %DLCO, and that patients in the tolerant group could benefit from the use of pirfenidone.
本研究的目的是评估吡非尼酮对特发性肺纤维化（IPF）患者的疗效和耐受性，并确定吡非尼酮耐受性的预测因素。
我们进行了一项回顾性观察研究。当患者的用力肺活量百分比（%FVC）恶化、经历急性加重或严重不良事件时，停止对其使用吡非尼酮治疗。我们将吡非尼酮治疗六个月后未出现病情进展的患者分类为耐受组，将出现病情进展的患者分类为不耐受组。我们回顾性分析了两组在基线特征方面的差异。通过耐受组治疗开始前后肺活量（VC）和%FVC的变化来评估吡非尼酮的疗效。共有20例被诊断为IPF的患者接受了吡非尼酮治疗。
与不耐受组相比，耐受组的基线%FVC（p = ０.０１）和肺一氧化碳弥散量百分比（DLCO，p = ０.０２）显著更高，而基线综合生理指数（CPI）显著更低（p = ０.００９）。在耐受组中，吡非尼酮显著降低了患者治疗后的VC和%FVC下降。在不耐受组中，有5例患者因厌食而停止吡非尼酮治疗。
我们发现，根据基线CPI、%FVC和%DLCO表明，病情症状较轻的患者对吡非尼酮的耐受性更好，并且耐受组的患者可以从使用吡非尼酮中获益。
