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Safety and Efficacy of Pirfenidone in Patients With Idiopathic Pulmonary Fibrosis

A Randomized, Double-Blind, Placebo Controlled, Phase 3 Study of the Safety and Efficacy of Pirfenidone in Patients With Idiopathic Pulmonary Fibrosis

Status
Completed
Phases
Phase 3
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00287729
Enrollment
344
Registered
2006-02-07
Start date
2006-04-30
Completion date
2008-11-30
Last updated
2017-04-17

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Idiopathic Pulmonary Fibrosis

Keywords

Idiopathic, Pulmonary, Fibrosis, Lung, Pirfenidone, InterMune

Brief summary

The purposes of this study are to assess the efficacy of treatment with pirfenidone 2403 milligrams per day compared with placebo in patients with idiopathic pulmonary fibrosis (IPF)and to assess the safety of treatment with pirfenidone 2403 milligrams per day compared with placebo in patients with idiopathic pulmonary fibrosis.

Detailed description

This is a Phase 3, randomized, double-blind, placebo-controlled, safety and efficacy study of pirfenidone in patients with idiopathic pulmonary fibrosis (IPF). Approximately 320 patients at approximately 50 centers will be randomly assigned (1:1) to receive pirfenidone 2403 milligrams or placebo equivalent administered in divided doses three times per day (TID) with food. The primary outcome variable will be the absolute change in percent predicted Forced Vital Capacity from Baseline to Week 72. Patients will be randomized by geographic region. Patients will receive blinded study treatment from the time of randomization until the last patient randomized has been treated for 72 weeks. A Data Monitoring Committee (DMC) will periodically review safety and efficacy data to ensure patient safety. After week 72, patients who meet the Progression of Disease (POD) definition, which is a ≥ 10% absolute decrease in percent predicted Forced Vital Capacity or a ≥ 15% absolute decrease in percent predicted carbon monoxide diffusing capacity (DLco), will be eligible to receive permitted idiopathic pulmonary fibrosis therapies in addition to their blinded study drug. Permitted idiopathic pulmonary therapies include corticosteroids, azathioprine, cyclophosphamide and N-acetyl-cysteine (with restrictions).

Interventions

DRUGPirfenidone

2403 mg/day given orally, and administered in divided doses three times daily with food, for the duration of the study.

DRUGPlacebo

Placebo equivalent, given orally, and administered in divided doses three times daily with food, for the duration of the study.

Sponsors

Genentech, Inc.
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
40 Years to 80 Years
Healthy volunteers
No

Inclusion criteria

Primary Inclusion criteria: * diagnosis of idiopathic pulmonary fibrosis * 40 to 80 years of age * Forced Vital Capacity ≥ 50% predicted value * carbon monoxide diffusing capacity (DLco) ≥ 35% predicted value * either Forced Vital Capacity or carbon monoxide diffusing capacity (DLco) ≤ 90% predicted value * no improvement in past year * able to walk 150 meters in 6 minutes and maintain saturation ≥ 83% while on no more than 6 liters per minute supplemental oxygen Primary

Exclusion criteria

* unable to undergo pulmonary function testing * evidence of significant obstructive lung disease or airway hyper-responsiveness * in the clinical opinion of the investigator, the patient is expected to need and be eligible for a lung transplant within 72 weeks of randomization * active infection * liver disease * cancer or other medical condition likely to result in death within 2 years * diabetes * pregnancy or lactation * substance abuse * personal or family history of long QT syndrome * other IPF treatment * unable to take study medication * withdrawal from other IPF trials

Design outcomes

Primary

MeasureTime frameDescription
Absolute Change in Percent Predicted Forced Vital Capacity(FVC)Baseline to week 72Mean Change in Percent Predicted Forced Vital Capacity (FVC) as measured from baseline to week 72. It is calculated as the simple difference between baseline Percent Predicted FVC measurements and week 72 Percent Predicted FVC measurements.

Secondary

MeasureTime frameDescription
Categorical Assessment of Absolute Change in Percent Predicted Forced Vital CapacityBaseline to week 72Based on the change in baseline percent predicted FVC at week 72, patients were assigned to 1 of 5 categories: mild decline (\<10% but \>=0% decline), moderate decline (\<20% but \>=10% decline), severe decline (\>=20% decline), mild improvement (\>0% but \<10% improvement), or moderate improvement (\>=10% improvement). Those who died or had a lung transplant before Week 72 were included in the severe decline category. The results indicate the number of patients who experience Categorical Change in Percent Predicted Forced Vital Capacity.
Progression-free SurvivalBaseline to Week 72Progression is defined as the first occurrence of a 10% absolute decline from baseline in percent predicted Forced Vital Capacity, a 15% absolute decline from baseline in percent predicted hemoglobin(Hgb)-corrected carbon monoxide diffusing capacity (DLco), or, death.
Change in the Six-Minute Walk Test (6MWT) DistanceBaseline to Week 72The change from Baseline to week 72 in distance walked during the 6-Minute Walk Test. This measure was calculated as the simple difference between baseline distanced walked over 6 minutes and week 72 distance walked over 6 minutes as measured in meters (m).
Change in Worst Oxygen Saturation by Pulse Oximetry (SpO2) Measurement Observed During the 6-Minute Walk TestBaseline to Week 72The change from baseline to week 72 in worst oxygen saturation during the 6-Minute Walk Test as measure by Pulse Oximetry (SpO2) Level. It is calculated as the simple difference between baseline SpO2 measurements and week 72 SpO2 measurements.
Change in Percent Predicted Hemoglobin (Hb)-Corrected Carbon Monoxide Diffusing Capacity (DLco) of the LungsBaseline to Week 72The change from baseline to week 72 in Percent Predicted Hemoglobin (Hb)-Corrected Carbon Monoxide Diffusing Capacity (DLco) of the Lungs. It is calculated as the simple difference between baseline DLco measurements and week 72 DLco measurements.
Change in Dyspnea ScoreBaseline to Week 72The mean change from baseline to week 72 in Dyspnea score was measured by the University of San Diego Shortness of Breath Questionnaire (UCSD SOBQ). The SOBQ is used to assess shortness of breath with various activities of daily living (for example, brushing ones teeth or mowing the lawn). Patients rated the severity of their shortness of breath experienced on an average day during the past week on a 6 point scale (0 to 5),with 0= not at all breathless, 4= severely breathless and 5= Maximally or unable to do because of breathlessness.
Worsening of IPFTime to acute IPF exacerbation, IPF-related death, lung transplant or respiratory hospitalization, whichever comes first.Worsening of IPF was defined by the occurrence of any of the following events: Acute IPF exacerbation, IPF-related death, Lung transplantation, or Respiratory hospitalization.

Countries

United States

Participant flow

Participants by arm

ArmCount
Pirfenidone (2403 mg/d)
pirfenidone, total daily dose of 2403 mg/day, given as 3 divided doses 3 times/day
171
Placebo
placebo equivalent, given as 3 divided doses 3 times/day
173
Total344

Baseline characteristics

CharacteristicPirfenidone (2403 mg/d)PlaceboTotal
Age, Categorical
<=18 years
0 Participants0 Participants0 Participants
Age, Categorical
>=65 years
101 Participants112 Participants213 Participants
Age, Categorical
Between 18 and 65 years
70 Participants61 Participants131 Participants
Age, Continuous66.8 years
STANDARD_DEVIATION 7.9
67.0 years
STANDARD_DEVIATION 7.8
66.9 years
STANDARD_DEVIATION 7.84
Region of Enrollment
Australia
0 participants1 participants1 participants
Region of Enrollment
Europe
23 participants22 participants45 participants
Region of Enrollment
United States
148 participants150 participants298 participants
Sex: Female, Male
Female
48 Participants49 Participants97 Participants
Sex: Female, Male
Male
123 Participants124 Participants247 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
— / —— / —
other
Total, other adverse events
169 / 171170 / 173
serious
Total, serious adverse events
53 / 17151 / 173

Outcome results

Primary

Absolute Change in Percent Predicted Forced Vital Capacity(FVC)

Mean Change in Percent Predicted Forced Vital Capacity (FVC) as measured from baseline to week 72. It is calculated as the simple difference between baseline Percent Predicted FVC measurements and week 72 Percent Predicted FVC measurements.

Time frame: Baseline to week 72

Population: A modified intent-to-treat population of all randomized patients who received any amount of study drug is the primary population for efficacy and safety analyses. Missing FVC data due to death were assigned the worst rank and missing FVC data due to reasons other than death were imputed using the SSD method.

ArmMeasureValue (MEAN)Dispersion
Pirfenidone (2403 mg/d)Absolute Change in Percent Predicted Forced Vital Capacity(FVC)-9 Change in Percent Predicted FVCStandard Deviation 19.58
PlaceboAbsolute Change in Percent Predicted Forced Vital Capacity(FVC)-10 Change in Percent Predicted FVCStandard Deviation 19.12
Secondary

Categorical Assessment of Absolute Change in Percent Predicted Forced Vital Capacity

Based on the change in baseline percent predicted FVC at week 72, patients were assigned to 1 of 5 categories: mild decline (\<10% but \>=0% decline), moderate decline (\<20% but \>=10% decline), severe decline (\>=20% decline), mild improvement (\>0% but \<10% improvement), or moderate improvement (\>=10% improvement). Those who died or had a lung transplant before Week 72 were included in the severe decline category. The results indicate the number of patients who experience Categorical Change in Percent Predicted Forced Vital Capacity.

Time frame: Baseline to week 72

Population: A modified intent-to-treat population of all randomized patients who received any amount of study drug is used as the primary population for all efficacy and safety analyses. Missing data were imputed by the SSD method if the patient was alive and imputed to 0% if the patient died before the protocol-specified time point.

ArmMeasureGroupValue (NUMBER)
Pirfenidone (2403 mg/d)Categorical Assessment of Absolute Change in Percent Predicted Forced Vital CapacityDecline <20% but >= 10%19 Patients
Pirfenidone (2403 mg/d)Categorical Assessment of Absolute Change in Percent Predicted Forced Vital CapacityImprovement of >=0% but <10%41 Patients
Pirfenidone (2403 mg/d)Categorical Assessment of Absolute Change in Percent Predicted Forced Vital CapacityDecline <10% but > 0%88 Patients
Pirfenidone (2403 mg/d)Categorical Assessment of Absolute Change in Percent Predicted Forced Vital CapacityImprovement of >=10%3 Patients
Pirfenidone (2403 mg/d)Categorical Assessment of Absolute Change in Percent Predicted Forced Vital CapacityDecline >=20% or death or lung transplantation20 Patients
PlaceboCategorical Assessment of Absolute Change in Percent Predicted Forced Vital CapacityImprovement of >=10%5 Patients
PlaceboCategorical Assessment of Absolute Change in Percent Predicted Forced Vital CapacityDecline >=20% or death or lung transplantation23 Patients
PlaceboCategorical Assessment of Absolute Change in Percent Predicted Forced Vital CapacityDecline <20% but >= 10%23 Patients
PlaceboCategorical Assessment of Absolute Change in Percent Predicted Forced Vital CapacityDecline <10% but > 0%89 Patients
PlaceboCategorical Assessment of Absolute Change in Percent Predicted Forced Vital CapacityImprovement of >=0% but <10%33 Patients
Secondary

Change in Dyspnea Score

The mean change from baseline to week 72 in Dyspnea score was measured by the University of San Diego Shortness of Breath Questionnaire (UCSD SOBQ). The SOBQ is used to assess shortness of breath with various activities of daily living (for example, brushing ones teeth or mowing the lawn). Patients rated the severity of their shortness of breath experienced on an average day during the past week on a 6 point scale (0 to 5),with 0= not at all breathless, 4= severely breathless and 5= Maximally or unable to do because of breathlessness.

Time frame: Baseline to Week 72

Population: A modified intent-to-treat population of all randomized patients who received any amount of study drug is used as the primary population for efficacy and safety analyses.~Missing data were imputed by the SSD method if the patient was alive and imputed to a score of 120 if the patient died before the protocol-specified time point.

ArmMeasureValue (MEAN)Dispersion
Pirfenidone (2403 mg/d)Change in Dyspnea Score11.9 Change in Dyspnea ScoreStandard Deviation 24.72
PlaceboChange in Dyspnea Score13.9 Change in Dyspnea ScoreStandard Deviation 27.89
Secondary

Change in Percent Predicted Hemoglobin (Hb)-Corrected Carbon Monoxide Diffusing Capacity (DLco) of the Lungs

The change from baseline to week 72 in Percent Predicted Hemoglobin (Hb)-Corrected Carbon Monoxide Diffusing Capacity (DLco) of the Lungs. It is calculated as the simple difference between baseline DLco measurements and week 72 DLco measurements.

Time frame: Baseline to Week 72

Population: A modified intent-to-treat population of all randomized patients who received any amount of study drug is used as the primary population for efficacy and safety analyses. Missing data were imputed by the SSD method if the patient was alive and imputed to 0% if the patient died before the protocol-specified time point.

ArmMeasureValue (MEAN)Dispersion
Pirfenidone (2403 mg/d)Change in Percent Predicted Hemoglobin (Hb)-Corrected Carbon Monoxide Diffusing Capacity (DLco) of the Lungs-9.8 Change in Percent Predicted DLcoStandard Deviation 12.61
PlaceboChange in Percent Predicted Hemoglobin (Hb)-Corrected Carbon Monoxide Diffusing Capacity (DLco) of the Lungs-9.2 Change in Percent Predicted DLcoStandard Deviation 13.24
Secondary

Change in the Six-Minute Walk Test (6MWT) Distance

The change from Baseline to week 72 in distance walked during the 6-Minute Walk Test. This measure was calculated as the simple difference between baseline distanced walked over 6 minutes and week 72 distance walked over 6 minutes as measured in meters (m).

Time frame: Baseline to Week 72

Population: A modified intent-to-treat population of all randomized patients who received any amount of study drug is used as the primary population for efficacy and safety analyses. Missing data were imputed by the SSD method if the patient was alive and imputed to 0 meters if the patient had died before the protocol-specified time point.

ArmMeasureValue (MEAN)Dispersion
Pirfenidone (2403 mg/d)Change in the Six-Minute Walk Test (6MWT) Distance-45 Change in Distance Walked in MetersStandard Deviation 140
PlaceboChange in the Six-Minute Walk Test (6MWT) Distance-77 Change in Distance Walked in MetersStandard Deviation 128
Secondary

Change in Worst Oxygen Saturation by Pulse Oximetry (SpO2) Measurement Observed During the 6-Minute Walk Test

The change from baseline to week 72 in worst oxygen saturation during the 6-Minute Walk Test as measure by Pulse Oximetry (SpO2) Level. It is calculated as the simple difference between baseline SpO2 measurements and week 72 SpO2 measurements.

Time frame: Baseline to Week 72

Population: A modified intent-to-treat population of all randomized patients who received any amount of study drug is used as the primary population for efficacy and safety analyses. Missing data were imputed by the SSD method if the patient was alive and imputed to 83% if the patient died before the protocol-specified time point.

ArmMeasureValue (MEAN)Dispersion
Pirfenidone (2403 mg/d)Change in Worst Oxygen Saturation by Pulse Oximetry (SpO2) Measurement Observed During the 6-Minute Walk Test-1.9 Change,Worst Oxygen Saturation (Percent)Standard Deviation 3.83
PlaceboChange in Worst Oxygen Saturation by Pulse Oximetry (SpO2) Measurement Observed During the 6-Minute Walk Test-1.3 Change,Worst Oxygen Saturation (Percent)Standard Deviation 6.63
Secondary

Progression-free Survival

Progression is defined as the first occurrence of a 10% absolute decline from baseline in percent predicted Forced Vital Capacity, a 15% absolute decline from baseline in percent predicted hemoglobin(Hgb)-corrected carbon monoxide diffusing capacity (DLco), or, death.

Time frame: Baseline to Week 72

Population: A modified intent-to-treat population of all randomized patients who received any amount of study drug is used as the primary population for efficacy and safety analyses.

ArmMeasureGroupValue (NUMBER)
Pirfenidone (2403 mg/d)Progression-free SurvivalDeath or Disease Progression54 Number of Patients with Progression
Pirfenidone (2403 mg/d)Progression-free SurvivalDecline in percent predicted FVC >=10%31 Number of Patients with Progression
Pirfenidone (2403 mg/d)Progression-free SurvivalDecline in percent predicted DLco >=15%10 Number of Patients with Progression
Pirfenidone (2403 mg/d)Progression-free SurvivalDeath Before Disease Progression13 Number of Patients with Progression
PlaceboProgression-free SurvivalDeath Before Disease Progression10 Number of Patients with Progression
PlaceboProgression-free SurvivalDeath or Disease Progression60 Number of Patients with Progression
PlaceboProgression-free SurvivalDecline in percent predicted DLco >=15%9 Number of Patients with Progression
PlaceboProgression-free SurvivalDecline in percent predicted FVC >=10%41 Number of Patients with Progression
Secondary

Worsening of IPF

Worsening of IPF was defined by the occurrence of any of the following events: Acute IPF exacerbation, IPF-related death, Lung transplantation, or Respiratory hospitalization.

Time frame: Time to acute IPF exacerbation, IPF-related death, lung transplant or respiratory hospitalization, whichever comes first.

Population: A modified intent-to-treat population of all randomized patients who received any amount of study drug is used as the primary population for efficacy and safety analyses.

ArmMeasureGroupValue (NUMBER)
Pirfenidone (2403 mg/d)Worsening of IPFWoresening IPF24 Number of Patients Who Worsened
Pirfenidone (2403 mg/d)Worsening of IPFAcute IPF exacerbation2 Number of Patients Who Worsened
Pirfenidone (2403 mg/d)Worsening of IPFIPF-related death3 Number of Patients Who Worsened
Pirfenidone (2403 mg/d)Worsening of IPFLung transplantation2 Number of Patients Who Worsened
Pirfenidone (2403 mg/d)Worsening of IPFRespiratory hospitalization17 Number of Patients Who Worsened
Pirfenidone (2403 mg/d)Worsening of IPFPatients Censored146 Number of Patients Who Worsened
PlaceboWorsening of IPFRespiratory hospitalization23 Number of Patients Who Worsened
PlaceboWorsening of IPFWoresening IPF32 Number of Patients Who Worsened
PlaceboWorsening of IPFLung transplantation2 Number of Patients Who Worsened
PlaceboWorsening of IPFAcute IPF exacerbation1 Number of Patients Who Worsened
PlaceboWorsening of IPFPatients Censored141 Number of Patients Who Worsened
PlaceboWorsening of IPFIPF-related death6 Number of Patients Who Worsened

Source: ClinicalTrials.gov · Data processed: Mar 29, 2026