Idiopathic Pulmonary Fibrosis
Conditions
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
2403 mg/day given orally, and administered in divided doses three times daily with food, for the duration of the study.
Placebo equivalent, given orally, and administered in divided doses three times daily with food, for the duration of the study.
Sponsors
Study design
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| Absolute Change in Percent Predicted Forced Vital Capacity(FVC) | Baseline to week 72 | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Categorical Assessment of Absolute Change in Percent Predicted Forced Vital Capacity | Baseline to week 72 | 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. |
| Progression-free Survival | Baseline to Week 72 | 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. |
| Change in the Six-Minute Walk Test (6MWT) Distance | Baseline to Week 72 | 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). |
| Change in Worst Oxygen Saturation by Pulse Oximetry (SpO2) Measurement Observed During the 6-Minute Walk Test | Baseline to Week 72 | 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. |
| Change in Percent Predicted Hemoglobin (Hb)-Corrected Carbon Monoxide Diffusing Capacity (DLco) of the Lungs | Baseline to Week 72 | 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. |
| Change in Dyspnea Score | Baseline to Week 72 | 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. |
| Worsening of IPF | Time 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
| Arm | Count |
|---|---|
| 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 |
| Total | 344 |
Baseline characteristics
| Characteristic | Pirfenidone (2403 mg/d) | Placebo | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 101 Participants | 112 Participants | 213 Participants |
| Age, Categorical Between 18 and 65 years | 70 Participants | 61 Participants | 131 Participants |
| Age, Continuous | 66.8 years STANDARD_DEVIATION 7.9 | 67.0 years STANDARD_DEVIATION 7.8 | 66.9 years STANDARD_DEVIATION 7.84 |
| Region of Enrollment Australia | 0 participants | 1 participants | 1 participants |
| Region of Enrollment Europe | 23 participants | 22 participants | 45 participants |
| Region of Enrollment United States | 148 participants | 150 participants | 298 participants |
| Sex: Female, Male Female | 48 Participants | 49 Participants | 97 Participants |
| Sex: Female, Male Male | 123 Participants | 124 Participants | 247 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 169 / 171 | 170 / 173 |
| serious Total, serious adverse events | 53 / 171 | 51 / 173 |
Outcome results
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.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Pirfenidone (2403 mg/d) | Absolute Change in Percent Predicted Forced Vital Capacity(FVC) | -9 Change in Percent Predicted FVC | Standard Deviation 19.58 |
| Placebo | Absolute Change in Percent Predicted Forced Vital Capacity(FVC) | -10 Change in Percent Predicted FVC | Standard Deviation 19.12 |
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.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Pirfenidone (2403 mg/d) | Categorical Assessment of Absolute Change in Percent Predicted Forced Vital Capacity | Decline <20% but >= 10% | 19 Patients |
| Pirfenidone (2403 mg/d) | Categorical Assessment of Absolute Change in Percent Predicted Forced Vital Capacity | Improvement of >=0% but <10% | 41 Patients |
| Pirfenidone (2403 mg/d) | Categorical Assessment of Absolute Change in Percent Predicted Forced Vital Capacity | Decline <10% but > 0% | 88 Patients |
| Pirfenidone (2403 mg/d) | Categorical Assessment of Absolute Change in Percent Predicted Forced Vital Capacity | Improvement of >=10% | 3 Patients |
| Pirfenidone (2403 mg/d) | Categorical Assessment of Absolute Change in Percent Predicted Forced Vital Capacity | Decline >=20% or death or lung transplantation | 20 Patients |
| Placebo | Categorical Assessment of Absolute Change in Percent Predicted Forced Vital Capacity | Improvement of >=10% | 5 Patients |
| Placebo | Categorical Assessment of Absolute Change in Percent Predicted Forced Vital Capacity | Decline >=20% or death or lung transplantation | 23 Patients |
| Placebo | Categorical Assessment of Absolute Change in Percent Predicted Forced Vital Capacity | Decline <20% but >= 10% | 23 Patients |
| Placebo | Categorical Assessment of Absolute Change in Percent Predicted Forced Vital Capacity | Decline <10% but > 0% | 89 Patients |
| Placebo | Categorical Assessment of Absolute Change in Percent Predicted Forced Vital Capacity | Improvement of >=0% but <10% | 33 Patients |
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.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Pirfenidone (2403 mg/d) | Change in Dyspnea Score | 11.9 Change in Dyspnea Score | Standard Deviation 24.72 |
| Placebo | Change in Dyspnea Score | 13.9 Change in Dyspnea Score | Standard Deviation 27.89 |
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.
| Arm | Measure | Value (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 DLco | Standard Deviation 12.61 |
| Placebo | Change in Percent Predicted Hemoglobin (Hb)-Corrected Carbon Monoxide Diffusing Capacity (DLco) of the Lungs | -9.2 Change in Percent Predicted DLco | Standard Deviation 13.24 |
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.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Pirfenidone (2403 mg/d) | Change in the Six-Minute Walk Test (6MWT) Distance | -45 Change in Distance Walked in Meters | Standard Deviation 140 |
| Placebo | Change in the Six-Minute Walk Test (6MWT) Distance | -77 Change in Distance Walked in Meters | Standard Deviation 128 |
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.
| Arm | Measure | Value (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 |
| Placebo | Change 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 |
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.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Pirfenidone (2403 mg/d) | Progression-free Survival | Death or Disease Progression | 54 Number of Patients with Progression |
| Pirfenidone (2403 mg/d) | Progression-free Survival | Decline in percent predicted FVC >=10% | 31 Number of Patients with Progression |
| Pirfenidone (2403 mg/d) | Progression-free Survival | Decline in percent predicted DLco >=15% | 10 Number of Patients with Progression |
| Pirfenidone (2403 mg/d) | Progression-free Survival | Death Before Disease Progression | 13 Number of Patients with Progression |
| Placebo | Progression-free Survival | Death Before Disease Progression | 10 Number of Patients with Progression |
| Placebo | Progression-free Survival | Death or Disease Progression | 60 Number of Patients with Progression |
| Placebo | Progression-free Survival | Decline in percent predicted DLco >=15% | 9 Number of Patients with Progression |
| Placebo | Progression-free Survival | Decline in percent predicted FVC >=10% | 41 Number of Patients with Progression |
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.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Pirfenidone (2403 mg/d) | Worsening of IPF | Woresening IPF | 24 Number of Patients Who Worsened |
| Pirfenidone (2403 mg/d) | Worsening of IPF | Acute IPF exacerbation | 2 Number of Patients Who Worsened |
| Pirfenidone (2403 mg/d) | Worsening of IPF | IPF-related death | 3 Number of Patients Who Worsened |
| Pirfenidone (2403 mg/d) | Worsening of IPF | Lung transplantation | 2 Number of Patients Who Worsened |
| Pirfenidone (2403 mg/d) | Worsening of IPF | Respiratory hospitalization | 17 Number of Patients Who Worsened |
| Pirfenidone (2403 mg/d) | Worsening of IPF | Patients Censored | 146 Number of Patients Who Worsened |
| Placebo | Worsening of IPF | Respiratory hospitalization | 23 Number of Patients Who Worsened |
| Placebo | Worsening of IPF | Woresening IPF | 32 Number of Patients Who Worsened |
| Placebo | Worsening of IPF | Lung transplantation | 2 Number of Patients Who Worsened |
| Placebo | Worsening of IPF | Acute IPF exacerbation | 1 Number of Patients Who Worsened |
| Placebo | Worsening of IPF | Patients Censored | 141 Number of Patients Who Worsened |
| Placebo | Worsening of IPF | IPF-related death | 6 Number of Patients Who Worsened |