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Khanna D, Albera C, Fischer A, Khalidi N, Raghu G, Chung L, Chen D, Schiopu E, Tagliaferri M, Seibold JR, Gorina E. An Open-label, Phase II Study of the Safety and Tolerability of Pirfenidone in Patients with Scleroderma-associated Interstitial Lung Disease: the LOTUSS Trial. J Rheumatol 2016; 43:1672-9. [PMID: 27370878 DOI: 10.3899/jrheum.151322] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Systemic sclerosis-associated interstitial lung disease (SSc-ILD) shares a number of clinical features and pathogenic mechanisms with idiopathic pulmonary fibrosis (IPF). This study was designed to evaluate the tolerability of the IPF treatment pirfenidone in SSc-ILD. The known gastrointestinal, skin, and liver adverse events (AE) of pirfenidone are of importance given the involvement of these organs in SSc. METHODS All patients received pirfenidone and were randomized 1:1 to either a 2- or 4-week titration starting at 801 mg/day and finishing at a maintenance dose of 2403 mg/day. Patients received pirfenidone for 16 weeks in total. Assessments included treatment-emergent AE (TEAE) and exploratory disease outcomes. RESULTS Sixty-three patients were randomized; 96.8% experienced a TEAE and more patients reported TEAE during the titration versus the maintenance period. The most commonly reported TEAE were consistent with those observed for pirfenidone in IPF (nausea, headache, fatigue) and were similar regardless of titration schedule. More patients discontinued treatment because of TEAE in the 2- versus 4-week titration group (5 vs 1, respectively); all discontinuation events occurred > 3 weeks after reaching the full dose of pirfenidone. Mycophenolate mofetil (MMF), taken by 63.5% of patients in addition to pirfenidone, did not appear to affect tolerability. Exploratory disease outcomes remained largely unchanged. CONCLUSION Pirfenidone showed an acceptable tolerability profile in SSc-ILD, although a longer titration may be associated with better tolerability. Tolerability was not affected by concomitant MMF. The present findings support further investigation of pirfenidone in future clinical trials in patients with SSc-ILD. TRIAL REGISTRATION ClinicalTrials.gov; www.clinicaltrials.gov NCT01933334.
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Affiliation(s)
- Dinesh Khanna
- From the University of Michigan, Ann Arbor, Michigan; University of Colorado, Denver, Colorado; University of Washington, Seattle, Washington; Stanford University School of Medicine; Jazz Pharmaceuticals, Palo Alto; InterMune Inc., Brisbane, California; Scleroderma Research Consultants LLC, Litchfield, Connecticut, USA; University of Turin, Turin, Italy; McMaster University, Hamilton, Ontario, Canada.D. Khanna, MD, MS, University of Michigan; C. Albera, MD, University of Turin; A. Fischer, MD, University of Colorado; N. Khalidi, MD, FRCPC, McMaster University; G. Raghu, MD, University of Washington; L. Chung, MD, Stanford University School of Medicine; D. Chen, MD, PhD, Jazz Pharmaceuticals, and formerly of InterMune; E. Schiopu, MD, University of Michigan; M. Tagliaferri, MD, formerly of InterMune; J.R. Seibold, MD, Scleroderma Research Consultants LLC; E. Gorina, MD, MS, formerly of InterMune.
| | - Carlo Albera
- From the University of Michigan, Ann Arbor, Michigan; University of Colorado, Denver, Colorado; University of Washington, Seattle, Washington; Stanford University School of Medicine; Jazz Pharmaceuticals, Palo Alto; InterMune Inc., Brisbane, California; Scleroderma Research Consultants LLC, Litchfield, Connecticut, USA; University of Turin, Turin, Italy; McMaster University, Hamilton, Ontario, Canada.D. Khanna, MD, MS, University of Michigan; C. Albera, MD, University of Turin; A. Fischer, MD, University of Colorado; N. Khalidi, MD, FRCPC, McMaster University; G. Raghu, MD, University of Washington; L. Chung, MD, Stanford University School of Medicine; D. Chen, MD, PhD, Jazz Pharmaceuticals, and formerly of InterMune; E. Schiopu, MD, University of Michigan; M. Tagliaferri, MD, formerly of InterMune; J.R. Seibold, MD, Scleroderma Research Consultants LLC; E. Gorina, MD, MS, formerly of InterMune
| | - Aryeh Fischer
- From the University of Michigan, Ann Arbor, Michigan; University of Colorado, Denver, Colorado; University of Washington, Seattle, Washington; Stanford University School of Medicine; Jazz Pharmaceuticals, Palo Alto; InterMune Inc., Brisbane, California; Scleroderma Research Consultants LLC, Litchfield, Connecticut, USA; University of Turin, Turin, Italy; McMaster University, Hamilton, Ontario, Canada.D. Khanna, MD, MS, University of Michigan; C. Albera, MD, University of Turin; A. Fischer, MD, University of Colorado; N. Khalidi, MD, FRCPC, McMaster University; G. Raghu, MD, University of Washington; L. Chung, MD, Stanford University School of Medicine; D. Chen, MD, PhD, Jazz Pharmaceuticals, and formerly of InterMune; E. Schiopu, MD, University of Michigan; M. Tagliaferri, MD, formerly of InterMune; J.R. Seibold, MD, Scleroderma Research Consultants LLC; E. Gorina, MD, MS, formerly of InterMune
| | - Nader Khalidi
- From the University of Michigan, Ann Arbor, Michigan; University of Colorado, Denver, Colorado; University of Washington, Seattle, Washington; Stanford University School of Medicine; Jazz Pharmaceuticals, Palo Alto; InterMune Inc., Brisbane, California; Scleroderma Research Consultants LLC, Litchfield, Connecticut, USA; University of Turin, Turin, Italy; McMaster University, Hamilton, Ontario, Canada.D. Khanna, MD, MS, University of Michigan; C. Albera, MD, University of Turin; A. Fischer, MD, University of Colorado; N. Khalidi, MD, FRCPC, McMaster University; G. Raghu, MD, University of Washington; L. Chung, MD, Stanford University School of Medicine; D. Chen, MD, PhD, Jazz Pharmaceuticals, and formerly of InterMune; E. Schiopu, MD, University of Michigan; M. Tagliaferri, MD, formerly of InterMune; J.R. Seibold, MD, Scleroderma Research Consultants LLC; E. Gorina, MD, MS, formerly of InterMune
| | - Ganesh Raghu
- From the University of Michigan, Ann Arbor, Michigan; University of Colorado, Denver, Colorado; University of Washington, Seattle, Washington; Stanford University School of Medicine; Jazz Pharmaceuticals, Palo Alto; InterMune Inc., Brisbane, California; Scleroderma Research Consultants LLC, Litchfield, Connecticut, USA; University of Turin, Turin, Italy; McMaster University, Hamilton, Ontario, Canada.D. Khanna, MD, MS, University of Michigan; C. Albera, MD, University of Turin; A. Fischer, MD, University of Colorado; N. Khalidi, MD, FRCPC, McMaster University; G. Raghu, MD, University of Washington; L. Chung, MD, Stanford University School of Medicine; D. Chen, MD, PhD, Jazz Pharmaceuticals, and formerly of InterMune; E. Schiopu, MD, University of Michigan; M. Tagliaferri, MD, formerly of InterMune; J.R. Seibold, MD, Scleroderma Research Consultants LLC; E. Gorina, MD, MS, formerly of InterMune
| | - Lorinda Chung
- From the University of Michigan, Ann Arbor, Michigan; University of Colorado, Denver, Colorado; University of Washington, Seattle, Washington; Stanford University School of Medicine; Jazz Pharmaceuticals, Palo Alto; InterMune Inc., Brisbane, California; Scleroderma Research Consultants LLC, Litchfield, Connecticut, USA; University of Turin, Turin, Italy; McMaster University, Hamilton, Ontario, Canada.D. Khanna, MD, MS, University of Michigan; C. Albera, MD, University of Turin; A. Fischer, MD, University of Colorado; N. Khalidi, MD, FRCPC, McMaster University; G. Raghu, MD, University of Washington; L. Chung, MD, Stanford University School of Medicine; D. Chen, MD, PhD, Jazz Pharmaceuticals, and formerly of InterMune; E. Schiopu, MD, University of Michigan; M. Tagliaferri, MD, formerly of InterMune; J.R. Seibold, MD, Scleroderma Research Consultants LLC; E. Gorina, MD, MS, formerly of InterMune
| | - Dan Chen
- From the University of Michigan, Ann Arbor, Michigan; University of Colorado, Denver, Colorado; University of Washington, Seattle, Washington; Stanford University School of Medicine; Jazz Pharmaceuticals, Palo Alto; InterMune Inc., Brisbane, California; Scleroderma Research Consultants LLC, Litchfield, Connecticut, USA; University of Turin, Turin, Italy; McMaster University, Hamilton, Ontario, Canada.D. Khanna, MD, MS, University of Michigan; C. Albera, MD, University of Turin; A. Fischer, MD, University of Colorado; N. Khalidi, MD, FRCPC, McMaster University; G. Raghu, MD, University of Washington; L. Chung, MD, Stanford University School of Medicine; D. Chen, MD, PhD, Jazz Pharmaceuticals, and formerly of InterMune; E. Schiopu, MD, University of Michigan; M. Tagliaferri, MD, formerly of InterMune; J.R. Seibold, MD, Scleroderma Research Consultants LLC; E. Gorina, MD, MS, formerly of InterMune
| | - Elena Schiopu
- From the University of Michigan, Ann Arbor, Michigan; University of Colorado, Denver, Colorado; University of Washington, Seattle, Washington; Stanford University School of Medicine; Jazz Pharmaceuticals, Palo Alto; InterMune Inc., Brisbane, California; Scleroderma Research Consultants LLC, Litchfield, Connecticut, USA; University of Turin, Turin, Italy; McMaster University, Hamilton, Ontario, Canada.D. Khanna, MD, MS, University of Michigan; C. Albera, MD, University of Turin; A. Fischer, MD, University of Colorado; N. Khalidi, MD, FRCPC, McMaster University; G. Raghu, MD, University of Washington; L. Chung, MD, Stanford University School of Medicine; D. Chen, MD, PhD, Jazz Pharmaceuticals, and formerly of InterMune; E. Schiopu, MD, University of Michigan; M. Tagliaferri, MD, formerly of InterMune; J.R. Seibold, MD, Scleroderma Research Consultants LLC; E. Gorina, MD, MS, formerly of InterMune
| | - Margit Tagliaferri
- From the University of Michigan, Ann Arbor, Michigan; University of Colorado, Denver, Colorado; University of Washington, Seattle, Washington; Stanford University School of Medicine; Jazz Pharmaceuticals, Palo Alto; InterMune Inc., Brisbane, California; Scleroderma Research Consultants LLC, Litchfield, Connecticut, USA; University of Turin, Turin, Italy; McMaster University, Hamilton, Ontario, Canada.D. Khanna, MD, MS, University of Michigan; C. Albera, MD, University of Turin; A. Fischer, MD, University of Colorado; N. Khalidi, MD, FRCPC, McMaster University; G. Raghu, MD, University of Washington; L. Chung, MD, Stanford University School of Medicine; D. Chen, MD, PhD, Jazz Pharmaceuticals, and formerly of InterMune; E. Schiopu, MD, University of Michigan; M. Tagliaferri, MD, formerly of InterMune; J.R. Seibold, MD, Scleroderma Research Consultants LLC; E. Gorina, MD, MS, formerly of InterMune
| | - James R Seibold
- From the University of Michigan, Ann Arbor, Michigan; University of Colorado, Denver, Colorado; University of Washington, Seattle, Washington; Stanford University School of Medicine; Jazz Pharmaceuticals, Palo Alto; InterMune Inc., Brisbane, California; Scleroderma Research Consultants LLC, Litchfield, Connecticut, USA; University of Turin, Turin, Italy; McMaster University, Hamilton, Ontario, Canada.D. Khanna, MD, MS, University of Michigan; C. Albera, MD, University of Turin; A. Fischer, MD, University of Colorado; N. Khalidi, MD, FRCPC, McMaster University; G. Raghu, MD, University of Washington; L. Chung, MD, Stanford University School of Medicine; D. Chen, MD, PhD, Jazz Pharmaceuticals, and formerly of InterMune; E. Schiopu, MD, University of Michigan; M. Tagliaferri, MD, formerly of InterMune; J.R. Seibold, MD, Scleroderma Research Consultants LLC; E. Gorina, MD, MS, formerly of InterMune
| | - Eduard Gorina
- From the University of Michigan, Ann Arbor, Michigan; University of Colorado, Denver, Colorado; University of Washington, Seattle, Washington; Stanford University School of Medicine; Jazz Pharmaceuticals, Palo Alto; InterMune Inc., Brisbane, California; Scleroderma Research Consultants LLC, Litchfield, Connecticut, USA; University of Turin, Turin, Italy; McMaster University, Hamilton, Ontario, Canada.D. Khanna, MD, MS, University of Michigan; C. Albera, MD, University of Turin; A. Fischer, MD, University of Colorado; N. Khalidi, MD, FRCPC, McMaster University; G. Raghu, MD, University of Washington; L. Chung, MD, Stanford University School of Medicine; D. Chen, MD, PhD, Jazz Pharmaceuticals, and formerly of InterMune; E. Schiopu, MD, University of Michigan; M. Tagliaferri, MD, formerly of InterMune; J.R. Seibold, MD, Scleroderma Research Consultants LLC; E. Gorina, MD, MS, formerly of InterMune
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