Abstract
Background; Pirfenidone (PFD), a new drug with anti-fibrotic effect, was approved for the treatment of idiopathic pulmonary fibrosis (IPF) in Japan in 2008. In prior clinical trials, this drug showed a clinical effect decelerating the progression of restrictive respiratory disturbance, particularly in patients with higher vital capacity (%VC>70%) at baseline. Previous study showed surfactant protein D (SP-D), a serum marker of IPF, predicts the annual decrease of VC (ΔVC/y) and the prognosis in the natural course of IPF. In this study, we investigated whether SP-D could predict the effect of PFD.
Methods; We enrolled 54 patients with IPF who visited our hospital from 2008 to 2012, fulfilled the criteria of the ATS/ERS/JRS/ALAT statement 2012, to the exclusion of exceptional cases such as familial onset and pleuroparenchymal fibroelastosis. They were divided in PFD-treated group (n=25) and PFD-non-treated group (n=29). Their mean observation period was 25.4 months (13.3-37.4). Distinct three serum markers including SP-D at baseline were analyzed retrospectively in relation to ΔVC/y.
Results; There was no significant difference between the two groups in patient’s characteristics, serum markers and VC at baseline. SP-D correlated significantly with ΔVC/y in both groups. The inhibitory effect of PFD on ΔVC/y was observed prominently in patients showing not only higher VC (%VC>70%) at baseline but also lower SP-D (under 220 ng/ml). This pharmacological effect was reproduced by evaluation restricted in patients showing higher VC at baseline.
Conclusion; SP-D and VC at baseline may be independent parameters to predict the effectiveness of PFD in patients with IPF.
- © 2013 ERS
