For the first time, researchers have shown that a class of anti-fibrotic drugs slows the progression of interstitial lung disease (IPD) in patients with rheumatoid arthritis (RA). Research conducted, in part, at National Jewish Health has shown pirfenidone to be safe and effective in these patients. The study published earlier this month in the journal Respiratory Medicine The Lancet is the first prospective treatment trial of patients with PR-ILD.
PID is a relatively common complication in people with RA and can progress and lead to premature death in up to 10% of these patients. This research is a big step forward for patients with PR-ILD.”
Joshua Solomon, MD, director of the Interstitial Lung Disease Program at National Jewish Health and first author of the study
Rheumatoid arthritis (RA) is one of the most common autoimmune diseases in the world. Treatment for Rheumatoid Arthritis and Interstitial Lung Disease 1 (TRIAL1) was a randomized, double-blind, placebo-controlled Phase 2 trial conducted at 34 academic IPD centers in four countries. Patients with PR-ILD were treated for 52 weeks with either the scar medication pirfenidone or a placebo. The COVID-19 pandemic prevented trial participant enrollment goals from being met, but results showed that pirfenidone was safe, well tolerated, and slowed the rate of progression of pulmonary fibrosis over one year. This was the first and only prospective international multicenter interventional treatment trial focused on RA-ILD. Although the trial was shortened due to recruitment difficulties during the pandemic, the intervention appeared safe and in context, slowed the rate of forced vital capacity (FVC) decline; as FVC decline is associated with earlier mortality, slower decline may be associated with longer lifespan.
“With this study, we demonstrate that anti-fibrotics as a class of drugs have a reproducible effect in reducing the rate of disease progression when measured by vital capacity strength,” said Dr. Ivan Rosas, corresponding author of the article and professor. of Medicine and Section Chief of Pulmonary Care, Critical Care, and Sleep Medicine at Baylor College of Medicine. “This could have an impact on the overall survival of these patients.”
Solomon, JJ, et al. (2022) Safety, tolerability and efficacy of pirfenidone in patients with interstitial lung disease associated with rheumatoid arthritis: a randomized, double-blind, placebo-controlled phase 2 study. Lancet Respiratory Medicine. doi.org/10.1016/S2213-2600(22)00260-0.