Takeaway
- In exploratory analysis of 2 pivotal pirfenidone (Esbriet; Genentech) trials, patients with idiopathic pulmonary fibrosis (IPF) experienced slower disease progression if they used an angiotensin-converting enzyme inhibitor (ACEi) vs using neither an ACEi nor angiotensin II receptor blockers (ARBs).
- Survival was worse with ARBs vs use of neither drug.
- Results are hypothesis-generating; prospective trials needed.
Why this matters
- Fibrosed lung contains abundant angiotensin peptides.
- Preclinical evidence suggests ACEi and ARB slow fibrosis.
Key results
- At baseline:
- 111 patients used an ACEi;
- 121 used ARBs; and
- 392 used neither (non-ACEi/ARB).
- Disease progression (HRs; 95% CIs):
- ACEi vs non-ACEi/ARB: 0.6 (0.4-0.9; P=.026).
- ARB vs non-ACEi/ARB: 0.9 (0.6-1.2; P=.413).
- Mortality (HRs; 95% CIs):
- ACEi vs non-ACEi/ARB: 1.1 (0.5-2.9; P=.782).
- ARB vs non-ACEi/ARB: 2.5 (1.2-5.2; P=.013).
- Similar trends, though not reaching significance, in pooled analysis with INSPIRE.
Study design
- Post hoc analysis of participants using placebo in CAPACITY and ASCEND (n=624).
- Stratifying by baseline antihypertensive, authors performed multivariate analysis.
- Outcome: composite of disease-progression measures, all-cause mortality at 52 weeks.
- For validation, authors pooled findings with data from INSPIRE.
- Funding: F. Hoffmann-La Roche Ltd.
Limitations
- Post hoc analysis; few events.
- Results might differ if patients were taking antifibrotics.
References
References