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Mandovra NP, Vaidya PJ, Shah RS, Nighojkar AS, Chavhan VB, Lohiya A, Leuppi JD, Leuppi-Taegtmeyer A, Chhajed PN. Factors Affecting Best-Tolerated Dose of Pirfenidone in Patients with Fibrosing Interstitial Lung Disease. J Clin Med 2023; 12:6513. [PMID: 37892651 PMCID: PMC10606989 DOI: 10.3390/jcm12206513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 10/29/2023] Open
Abstract
The aim of the study was to examine the best-tolerated dose of pirfenidone, the adverse effects profile, and potential factors other than drug dose influencing the tolerability of pirfenidone in patients with fibrosing interstitial lung diseases (ILDs). We performed an observational retrospective study of 113 patients with IPF and other fibrosing ILDs treated with pirfenidone. Baseline liver function tests (LFTs) and dose escalation of pirfenidone were recorded for all patients. The best-tolerated dose was continued if the patient did not tolerate full dose (2400 mg) despite repeated dose escalation attempts. Potential risk factors such as age, height, weight, body mass index (BMI), body surface area (BSA), gender, smoking, and presence of comorbidities were analyzed between 3 groups of best-tolerated pirfenidone doses: 2400 mg/day vs. <2400 mg/day, 2400 mg/day vs. 1800 mg/day, and 2400 mg/day vs. 1200 mg/day. A total of 24 patients tolerated 2400 mg/day, and 89 patients tolerated <2400 mg/day (43 tolerated 1800 mg/day, 45 tolerated 1200 mg/day and 1 tolerated 600 mg/day). Patients who tolerated 2400 mg/day were taller and had a larger BSA as compared to those tolerating <2400 mg/day. Overall, males tolerated the drug better. Presence of comorbidities or smoking did not affect the tolerance of pirfenidone, except for the presence of cerebrovascular diseases. Various adverse effects did not have any significantly different frequencies between the compared groups. Moreover, 71.7% of patients experienced at least one side effect. 1200 mg/day was the best-tolerated dose in the majority of the patients. Male patients with a larger BSA and greater height showed better tolerability of pirfenidone overall.
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Affiliation(s)
- Neha P. Mandovra
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai 400614, India
| | - Preyas J. Vaidya
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai 400614, India
| | - Ria S. Shah
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai 400614, India
| | - Aishwarya S. Nighojkar
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
| | - Vinod B. Chavhan
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
| | - Ayush Lohiya
- Kalyan Singh Super Speciality Cancer Institute, Lucknow 226002, India;
| | - Joerg D. Leuppi
- University Centre of Internal Medicine, Kantonsspital Baselland, 4410 Liestal, Switzerland; (J.D.L.); (A.L.-T.)
- Medical Faculty, University of Basel, 4031 Basel, Switzerland
| | - Anne Leuppi-Taegtmeyer
- University Centre of Internal Medicine, Kantonsspital Baselland, 4410 Liestal, Switzerland; (J.D.L.); (A.L.-T.)
- Medical Faculty, University of Basel, 4031 Basel, Switzerland
- Department of Patient Safety, Medical Directorate, University Hospital Basel, 4031 Basel, Switzerland
| | - Prashant N. Chhajed
- Institute of Pulmonology Medical Research and Development, Mumbai 400054, India; (N.P.M.); (P.J.V.); (R.S.S.); (A.S.N.); (V.B.C.)
- Department of Respiratory Medicine, Fortis Hiranandani Hospital, Navi Mumbai 400614, India
- University Centre of Internal Medicine, Kantonsspital Baselland, 4410 Liestal, Switzerland; (J.D.L.); (A.L.-T.)
- Medical Faculty, University of Basel, 4031 Basel, Switzerland
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Choudhury S, Taweesedt PT, Dadhwal R, Surani S. Severe Photosensitivity Reaction After Pirfenidone Use. Cureus 2021; 13:e16626. [PMID: 34458037 PMCID: PMC8384726 DOI: 10.7759/cureus.16626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 11/05/2022] Open
Abstract
Idiopathic pulmonary fibrosis is a chronic and progressive disease with a significant mortality rate. Pirfenidone is one of two oral antifibrotic therapies approved to treat idiopathic pulmonary fibrosis (IPF). Pirfenidone helps decrease disease progression in patients with IPF and reduces vital capacity. This has led to widespread use of this medication in recent years. In this case report, we present a 60-year-old male who started treatment with pirfenidone for IPF and had severe skin reactions after initiation of therapy.
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Affiliation(s)
- Saiara Choudhury
- Internal Medicine, Corpus Christi Medical Center, Corpus Christi, USA
| | | | - Rahul Dadhwal
- Pulmonary Medicine, Corpus Christi Medical Center, Corpus Christi, USA
| | - Salim Surani
- Anesthesiology, Mayo Clinic, Rochester, USA.,Medicine, Texas A&M University, College Station, USA.,Medicine, University of North Texas, Dallas, USA.,Internal Medicine, Pulmonary Associates, Corpus Christi, USA.,Clinical Medicine, University of Houston, Houston, USA
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3
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A role for antimetabolites in glaucoma tube surgery: current evidence and future directions. Curr Opin Ophthalmol 2016; 27:164-9. [PMID: 26720778 DOI: 10.1097/icu.0000000000000244] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Glaucoma is the leading cause of irreversible blindness worldwide. The main treatment modality for glaucoma is the reduction and control of the intraocular pressure (IOP). Glaucoma filtration surgery, including trabeculectomy and/or implantation of a glaucoma drainage device (GDD), is warranted if IOP remains medically uncontrolled. However, postoperative scarring remains a critical determinant of long-term bleb survival and IOP control after drainage surgery. Antimetabolites, such as mitomycin C and 5-fluorouracil, have been used for many years to increase survival time of filtration surgeries by preventing bleb fibrosis and scarring. The aim of this study is to provide an overview of: the current usage of these antimetabolites in GDD, the recent advancements of these antimetabolites in combination with other technologies, and the role of future antimetabolites. RECENT FINDINGS Mitomycin C and 5-fluorouracil have been used in GDD and trabeculectomy to prevent the exaggerated cellular reaction that leads to fibrosis. The adjunctive administration of these drugs intraoperatively and postoperatively has resulted in a lower rate of the hypertensive phase, and possibly a better long-term success rate in Ahmed valve surgeries. However, the application of these antimetabolites and their multiple-dosing applications are associated with nonspecific cytotoxicity and potentially severe complications such as bleb leak and conjunctival erosion over the tube. Recent studies are thus focusing on different medications, targeting new molecular pathways, and designing new delivery vehicles to minimize current antimetabolites side-effects and increase their efficacy. Promising results of these studies have led to development of new collaborative medications and advanced drug delivery systems for better modulation of GDD surgeries' predictable outcomes. SUMMARY The development of small molecule therapeutics, combination therapies, and innovative drug vehicles to prevent postsurgical fibrosis and achieve better surgical outcome in glaucoma filtration surgeries is promising.
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Fuger M, Clair MP, El Ayoun Ibrahim N, L'Excellent S, Nizery L, O'Neill C, Tabone L, Truffinet O, Yakovleff C, de Blic J. [Chronic interstitial lung disease in children: Diagnostic approach and management]. Arch Pediatr 2016; 23:525-31. [PMID: 27021883 DOI: 10.1016/j.arcped.2016.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 01/05/2016] [Accepted: 02/23/2016] [Indexed: 02/06/2023]
Abstract
Chronic interstitial lung disease (ILD) in children is a heterogeneous group of rare lung disorders characterized by an inflammatory process of the alveolar wall and the pulmonary interstitium that induces gas exchange disorders. The diagnostic approach to an ILD involves three essential steps: recognizing the ILD, appreciating the impact, and identifying the cause. The spectrum of clinical findings depends to a large extent on age. In the newborn, the beginning is often abrupt (neonatal respiratory distress), whereas there is a more gradual onset in infants (failure to thrive, tachypnea, indrawing of the respiratory muscles). In older children, the onset is insidious and the diagnosis can only be made at an advanced stage of the disease. The diagnosis is based on noninvasive methods (clinical history, respiratory function tests, chest X-ray, and high-resolution CT scan) and invasive techniques (bronchoalveolar lavage, transbronchial biopsy, video-assisted thoracoscopic biopsy, and open lung biopsy). The treatment of interstitial lung disease in children depends on the nature of the underlying pathology. The most common therapeutic approach involves the use of corticosteroids and immunosuppressive agents for their anti-inflammatory and antifibrotic effects. Children with ILD also need support therapy (oxygen therapy, nutritional support, treatment of pulmonary arterial hypertension, vaccination). Lung transplantation is discussed in patients with severe respiratory failure.
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Affiliation(s)
- M Fuger
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France.
| | - M-P Clair
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - N El Ayoun Ibrahim
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - S L'Excellent
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - L Nizery
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - C O'Neill
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - L Tabone
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - O Truffinet
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - C Yakovleff
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - J de Blic
- Service de pneumologie pédiatrique, hôpital Necker-Enfants-Malades, AP-HP, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
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Papakonstantinou E, Prasse A, Schacht V, Kapp A, Raap U. Pirfenidone-induced severe phototoxic reaction in a patient with idiopathic lung fibrosis. J Eur Acad Dermatol Venereol 2016; 30:1354-6. [DOI: 10.1111/jdv.13657] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/12/2016] [Indexed: 11/26/2022]
Affiliation(s)
- E. Papakonstantinou
- Department of Dermatology and Venereology; Hannover Medical School; Hannover Germany
| | - A. Prasse
- Department of Pulmonology; Hannover Medical School; Hannover Germany
| | - V. Schacht
- Department of Dermatology and Venereology; Hannover Medical School; Hannover Germany
| | - A. Kapp
- Department of Dermatology and Venereology; Hannover Medical School; Hannover Germany
| | - U. Raap
- Department of Dermatology and Venereology; Hannover Medical School; Hannover Germany
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6
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Luo B, Zhang Y, You Y, Weng Z. Synthesis of trifluoromethylthiolated pyridinones through the copper-mediated trifluoromethylthiolation of iodopyridinones. Org Biomol Chem 2016; 14:8615-8622. [DOI: 10.1039/c6ob01348a] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A simple method for the synthesis of trifluoromethylthiolated pyridinones through the copper-mediated trifluoromethylthiolation of iodopyridinones was developed.
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Affiliation(s)
- Beibei Luo
- State Key Laboratory of Photocatalysis on Energy and Environment
- College of Chemistry
- Fuzhou University
- Fuzhou 350108
- China
| | - Yunxiao Zhang
- State Key Laboratory of Photocatalysis on Energy and Environment
- College of Chemistry
- Fuzhou University
- Fuzhou 350108
- China
| | - Yi You
- State Key Laboratory of Photocatalysis on Energy and Environment
- College of Chemistry
- Fuzhou University
- Fuzhou 350108
- China
| | - Zhiqiang Weng
- State Key Laboratory of Photocatalysis on Energy and Environment
- College of Chemistry
- Fuzhou University
- Fuzhou 350108
- China
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7
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Pineton de Chambrun M, Nunes H, Brochériou I, Hertig A. Idiopathic lung fibrosis and anti myeloperoxidase glomerulonephritis: the tree that hides the forest. BMC Pulm Med 2015; 15:130. [PMID: 26502884 PMCID: PMC4623276 DOI: 10.1186/s12890-015-0129-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/15/2015] [Indexed: 11/10/2022] Open
Abstract
Background Although anti-neutrophil cytoplasmic antibodies [ANCA] are frequently found in patients diagnosed with idiopathic pulmonary fibrosis [IPF], current guidance does not recommend serologic testing for vasculitis. Case presentation A 71-year old Caucasian male, diagnosed with IPF three years earlier, presented with rapidly progressive glomerulonephritis. ANCA were found both in current and historical sera. A kidney biopsy sample was taken, which revealed a pauci-immune glomerulonephritis, but also areas of glomerular fibrosis, hence strongly suggesting unrecognized flares of an indolent vasculitis in his past. This made the diagnosis of “idiopathic” pulmonary fibrosis very unlikely. Conclusion As nephrologists, we argue that testing for ANCA should be performed on a systematic basis, at least in elderly patients, even in the absence of extra-pulmonary signs of vasculitis at presentation.
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Affiliation(s)
- Marc Pineton de Chambrun
- APHP, Hôpital Tenon, Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
| | - Hilario Nunes
- APHP, Hôpital d'Avicenne, Service de Pneumologie, Bobigny, France. .,Université Paris 13, Sorbonne Paris Cité, EA2363 "Réponses cellulaires et fonctionnelles à l'hypoxie", Paris, France.
| | - Isabelle Brochériou
- APHP, Hôpital Tenon, Anatomopathologie, Paris, France. .,UPMC Sorbonne Université Paris 06, UMR S 1155, F-75020, Paris, France.
| | - Alexandre Hertig
- APHP, Hôpital Tenon, Urgences Néphrologiques et Transplantation Rénale, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France. .,UPMC Sorbonne Université Paris 06, UMR S 1155, F-75020, Paris, France.
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8
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Huang H, Dai HP, Kang J, Chen BY, Sun TY, Xu ZJ. Double-Blind Randomized Trial of Pirfenidone in Chinese Idiopathic Pulmonary Fibrosis Patients. Medicine (Baltimore) 2015; 94:e1600. [PMID: 26496265 PMCID: PMC4620844 DOI: 10.1097/md.0000000000001600] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) lacks effective treatment. Pirfenidone has been used to treat IPF patients. N-acetylcysteine (NAC) exerts antioxidant and antifibrotic effects on IPF cases.This study is a double-blind, modified placebo-controlled, randomized phase II trial of pirfenidone in Chinese IPF patients. We randomly assigned the enrolled Chinese IPF patients with mild to moderate impairment of pulmonary function to receive either oral pirfenidone (1800 mg per day) and NAC (1800 mg per day) or placebo and NAC (1800 mg per day) for 48 weeks. The primary endpoints were the changes in forced vital capacity (FVC) and walking distance and the lowest SPO2 during the 6-minute walk test (6MWT) at week 48. The key secondary endpoint was the progression-free survival time. This study is registered in ClinicalTrials.gov as number NCT01504334.Eighty-six patients were screened, and 76 cases were enrolled (pirfenidone + NAC: 38; placebo + NAC: 38). The effect of pirfenidone treatment was significant at the 24th week, but this effect did not persist to the 48th week. At the 24th week, the mean decline in both FVC and ΔSPO2 (%) during the 6MWT in the pirfenidone group was lower than that in the control group (-0.08 ± 0.20 L vs -0.22 ± 0.29 L, P = 0.02 and -3.44% ± 4.51% vs -6.29% ± 6.06%, P = 0.03, respectively). However, there was no significant difference between these 2 groups at the 48th week (-0.15 ± 0.25 L vs -0.25 ± 0.28 L, P = 0.11 and -4.25% ± 7.27% vs -5.31% ± 5.49%, P = 0.51, respectively). The pirfenidone treatment group did not achieve the maximal distance difference on the 6MWT at either the 24th or the 48th week. But pirfenidone treatment prolonged the progression-free survival time in the IPF patients (hazard ratio = 1.88, 95% confidence interval: 1.092-3.242, P = 0.02). In the pirfenidone group, the adverse event (AE) rate (52.63%) was higher than that in the control group (26.3%, P = 0.03). Rash was more common in the pirfenidone group (39.5% vs 13.2%, P = 0.02).Compared with placebo combined with high-dose NAC, pirfenidone combined with high-dose NAC prolonged the progression-free survival of Chinese IPF patients with mild to moderate impairment of pulmonary function. (ClinicalTrials.gov number, NCT01504334).
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Affiliation(s)
- Hui Huang
- From the Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College (HH, ZJX); Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University; Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Institute of Respiratory Medicine, Beijing (HPD); Department of Respiratory Diseases, The First Affiliated Hospital of China Medical University, Shenyang (JK); Department of Respiratory Diseases, Tianjin Medical University General Hospital, Tianjin (BYC); and Department of Respiratory and Critical Care Medicine, Beijing Hospital, Beijing, China (TYS)
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9
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Practical considerations in the pharmacologic treatment of idiopathic pulmonary fibrosis. Curr Opin Pulm Med 2015; 21:479-89. [DOI: 10.1097/mcp.0000000000000190] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Antifibrotic effects of pirfenidone on Tenon's fibroblasts in glaucomatous eyes: comparison with mitomycin C and 5-fluorouracil. Graefes Arch Clin Exp Ophthalmol 2015; 253:1537-45. [PMID: 26047534 DOI: 10.1007/s00417-015-3068-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/22/2015] [Accepted: 05/15/2015] [Indexed: 01/14/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the antifibrotic effects of pirfenidone (PFD) on primary cultured human Tenon's fibroblasts (HTFs) from primary open-angle glaucoma (POAG) eyes, compared to mitomicin C (MMC) and 5-fluorouracil (5-FU). MATERIALS AND METHODS Samples of human Tenon's capsule were obtained during respective surgeries from three groups of patients: patients with cataract (CAT group), patients with POAG who underwent glaucoma filtration surgery (GFS) (POAG1 group), and patients with POAG who underwent GFS due to failed bleb of previous GFS (POAG2 group). Cell toxicity, cell migration, and the expression level of α-smooth muscle actin (α-SMA) protein were evaluated in primary cultured HTFs from the three patient groups after treatment (PFD, MMC, or 5-FU). RESULTS Overall, cell viability after PFD treatment was higher compared to MMC treatment (82.3 ± 5.1 % vs 56.7 ± 3.8 %; p = 0.001) and comparable to 5-FU treatment (82.3 ± 5.1 % vs 85.7 ± 10.7 %, p = 0.214) at the same concentration (0.4 mg/ml). Both 0.3 mg/ml PFD and 0.1 mg/ml MMC inhibited cell migration compared to control (without treatment) cells (p = 0.014 and 0.005, respectively), while 0.2 mg/ml 5-FU showed the highest degree of cell migration among the three agents in the POAG1 group (PFD vs MMC vs 5-FU; 29.5 ± 2.1 % vs 34.5 ± 0.7 % vs 76.0 ± 8.5 %, PFD vs MMC; p = 1.000, PFD vs 5-FU; p = 0.008, MMC vs 5-FU; p = 0.011). PFD (0.1 or 0.3 mg/ml) and MMC (0.05 and 0.1 mg/ml) treatment significantly reduced the protein expression level of α-SMA in the POAG 1 group (all p < 0.05), and the α-SMA protein level following treatment with 0.3 mg/ml PFD was lower than that of 0.1 mg/ml MMC (p = 0.040). CONCLUSION PFD showed less cytotoxicity compared to MMC. PFD and MMC inhibited cell migration and reduced α-SMA protein expression levels, while 5-FU showed neither inhibition of cell migration nor reduction in α-SMA expression level. These findings indicate PFD as a potential adjunctive antifibrotic agent to prevent bleb failure during GFS.
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11
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Determination and pharmacokinetic study of pirfenidone in rat plasma by UPLC–MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2015; 981-982:14-8. [DOI: 10.1016/j.jchromb.2014.12.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 11/30/2022]
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12
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Rogler G. New therapeutic avenues for treatment of fibrosis: can we learn from other diseases? Dig Dis 2014; 32 Suppl 1:39-49. [PMID: 25531352 DOI: 10.1159/000367825] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Crohn's disease (CD) is characterized by the frequent occurrence of complications, such as fibrotic strictures and subsequently the need for CD-related surgery. Chronic or recurrent inflammation is generally regarded to be a necessary precondition for the initiation of intestinal fibrosis. In this view, fibrosis is a pathologically augmented healing response to inflammation-induced mucosal tissue destruction and injury. At present, there are no approved or effective medical therapies aimed specifically at fibrosis or stricture in IBD. Indirect benefits may occur from anti-inflammatory therapies, although there is no consensus on this. Therapy for fibrosis is complicated by the fact that a wound-healing response is essential in CD and ulcerative colitis. Several pharmaceutical companies are now working on the therapy of fibrosis in other diseases. Strategies interfering with TGF-β expression and activation are promising. Pirfenidone has been studied in several clinical trials. Further therapeutic options are second-generation and wide-spectrum tyrosine kinase inhibitors. These inhibit growth factor receptor signaling, thus reducing fibrosis in animal models and some patients with tumor-associated fibrosis. At present, the development of antifibrotic therapies takes place in other diseases such as lung and liver fibrosis. This is partially due to a lack of experimental models for gut fibrosis and the fact that reliable readouts (MRI, serum markers) in patients are lacking. It will be important to test the above-mentioned newly available treatment strategies in IBD to profit from progress in other fibrotic diseases.
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Affiliation(s)
- Gerhard Rogler
- Division of Gastroenterology and Hepatology, University Hospital Zurich, and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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13
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Joos GF, Gabazza EC. Is there still hope for single therapies: how do we set up experimental systems to efficiently test combination therapies? Respirology 2014; 20:15-23. [PMID: 25410652 DOI: 10.1111/resp.12438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/10/2014] [Accepted: 09/02/2014] [Indexed: 12/14/2022]
Abstract
Severe asthma, chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) are chronic lung diseases with a clear need for development of new and more efficient therapy. In preclinical research, the mouse model has been instrumental in advancing our knowledge of the biology and immunology. However, it has been proven rather difficult and time consuming to develop new treatments that can impact on the clinical course of these diseases. Many challenges need to be overcome for upgrading the quality of currently available experimental disease models in order to enhance the translation rate of basic research to clinical practice. Establishment of transgenic mouse overexpressing disease-causing genes may provide tools to discover new pathological pathways and to evaluate the possibility of molecular targeted therapy in chronic lung diseases. Personalized medicine, if developed, might be the solution for 'disease heterogeneity' and for improving clinical outcome.
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Affiliation(s)
- Guy F Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
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14
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Hronová K, Šíma M, Světlík S, Matoušková O, Slanař O. Pharmacogenetics and immunosuppressive drugs. Expert Rev Clin Pharmacol 2014; 7:821-35. [PMID: 25301406 DOI: 10.1586/17512433.2014.966811] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Several candidate genes have been proposed as potential biomarkers for altered pharmacodynamics or pharmacokinetics of immunosuppressive drugs. However, there is usually only limited clinical evidence substantiating the implementation of biomarkers into clinical practice. Testing for thiopurine-S-methyltransferase polymorphisms has been put into routine clinical use quite widely, while the other pharmacogenetic tests are much less frequently used. Relatively good evidence appeared for tacrolimus-related biomarkers; thus, their utilization may be envisaged in the near future. Although the biomarkers related to mycophenolate, sirolimus or other drugs in the therapeutic class may be promising, further research is necessary to provide more robust evidence. The present review focuses on immunosuppressive drugs, excluding biological treatment.
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Affiliation(s)
- Karolína Hronová
- Department of Pharmacology, First Faculty of Medicine and General Teaching Hospital, Charles University in Prague, Albertov 4, CZ-128 00 Prague 2, Czech Republic
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Covvey JR, Mancl EE. Recent Evidence for Pharmacological Treatment of Idiopathic Pulmonary Fibrosis. Ann Pharmacother 2014; 48:1611-9. [DOI: 10.1177/1060028014551015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To describe emerging evidence for the pharmacological treatment of idiopathic pulmonary fibrosis (IPF). Data Sources: A search of PubMed (1966 to July 2014) was performed using the terms idiopathic pulmonary fibrosis and treatment. Study Selection and Data Extraction: Review of articles was restricted to articles in English and relating to placebo-controlled or comparative clinical trial data of recent significance. Evidence statements from the most recent international guidelines and some historical trial data were also included for context. Data Synthesis: Numerous treatment options have been evaluated for IPF. Therapies evaluated in large trials have either resulted in increased mortality (anticoagulation, triple-therapy with N-acetylcysteine [NAC], azathioprine, and prednisone) or demonstrated a lack of efficacy (endothelin receptor antagonists, single-agent NAC). Pirfenidone, a novel antifibrotic and anti-inflammatory agent, has demonstrated efficacy in several recent analyses and is the only approved medication for the treatment of IPF in more than 30 countries outside of the United States, with resubmission to the Food and Drug Administration (FDA) recently made. Nintedanib, a tyrosine kinase inhibitor, has demonstrated encouraging results in phase III studies and has also recently been submitted for FDA approval. Conclusions: Limited options have existed for the treatment of IPF. New evidence suggests that safe and efficacious treatment options for IPF are on the horizon in the form of pirfenidone and nintedanib, although both agents await FDA decisions.
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Affiliation(s)
- Jordan R. Covvey
- Duquesne University Mylan School of Pharmacy, Pittsburgh, PA, USA
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Widemann BC, Babovic-Vuksanovic D, Dombi E, Wolters PL, Goldman S, Martin S, Goodwin A, Goodspeed W, Kieran MW, Cohen B, Blaney SM, King A, Solomon J, Patronas N, Balis FM, Fox E, Steinberg SM, Packer RJ. Phase II trial of pirfenidone in children and young adults with neurofibromatosis type 1 and progressive plexiform neurofibromas. Pediatr Blood Cancer 2014; 61:1598-602. [PMID: 24753394 PMCID: PMC7681788 DOI: 10.1002/pbc.25041] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 03/03/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pirfenidone, an oral anti-inflammatory, antifibrotic agent with activity in idiopathic pulmonary fibrosis, may mediate anti-tumor activity in neurofibromatosis type 1 (NF1) and plexiform neurofibromas (PN) by inhibition of fibroblast proliferation and collagen synthesis. The primary objective of this open label, single arm phase II trial was to evaluate the activity of pirfenidone in children and young adults with inoperable PN. PROCEDURE Patients (3-21 years) with NF1-related progressive PN received pirfenidone at the previously determined optimal dose (500 mg/m(2) orally, q8h) on a continuous dosing schedule (one cycle = 28 days). Volumetric MRI analysis was used to assess response. Progression was defined as ≥ 20% PN volume increase compared to baseline. Pirfenidone would be considered active if it doubled the median time to progression (TTP) compared to the TTP on the placebo arm of a phase II trial with the farnesyltransferase inhibitor tipifarnib, which used near identical eligibility criteria. Toxicities, objective response rate, and quality of life (QOL) also were evaluated. RESULTS Thirty-six patients were enrolled and tolerated pirfenidone well with intermittent nausea and vomiting as the most frequent toxicities. A dose reduction was required in only three patients. The median TTP for pirfenidone was 13.2 months compared to 10.6 months for the placebo control group from the tipifarnib trial (two-tailed P = 0.92; one-tailed P = 0.46). No objective responses were observed. CONCLUSIONS Pirfenidone was well tolerated, but did not demonstrate activity as defined in this trial and does not warrant further evaluation in children with NF1 and progressive PN.
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Affiliation(s)
| | | | - Eva Dombi
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Pamela L. Wolters
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Stewart Goldman
- Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Staci Martin
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Anne Goodwin
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Wendy Goodspeed
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Mark W. Kieran
- Dana-Farber/Children’s Hospital Cancer Center, Boston, Massachusetts
| | | | | | - Allison King
- St. Louis Children’s Hospital, St. Louis, Missouri
| | | | - Nicholas Patronas
- Diagnostic Radiology Department, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Frank M. Balis
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elizabeth Fox
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Seth M. Steinberg
- Biostatistics and Data Management Section, National Cancer Institute, Bethesda, Maryland
| | - Roger J Packer
- Children’s National Medical Center, Washington, District of Columbia
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Michel MC. Hope for disease-modifying treatment of systemic sclerosis/scleroderma. J Pharmacol Exp Ther 2014; 350:480-2. [PMID: 25053235 DOI: 10.1124/jpet.114.213520comm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany; and Department of Translational Medicine and Clinical Pharmacokinetics, Boehringer Ingelheim Pharma GmbH, Ingelheim, Germany
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Xaubet A, Serrano-Mollar A, Ancochea J. Pirfenidone for the treatment of idiopathic pulmonary fibrosis. Expert Opin Pharmacother 2013; 15:275-81. [DOI: 10.1517/14656566.2014.867328] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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