title: Idiopathic pulmonary fibrosis: Recent advances on pharmacological therapy.
abstract: Idiopathic pulmonary fibrosis (IPF) is the most common and lethal of the idiopathic interstitial pneumonias with an estimated 5-year survival of approximately 20%. In the last two decades our understanding of disease pathogenesis has substantially evolved and novel compounds have been developed consequent to the increasing knowledge of the mechanisms underlying disease pathobiology. The disease appears to be driven - following chronic injury - by abnormal/dysfunctional alveolar epithelial cells that promote fibroblast recruitment and proliferation, resulting in scarring of the lung and irreversible loss of function. With very few exceptions, clinical trials evaluating novel potential therapies have provided disappointing results. More recently, pirfenidone and nintedanib, two compounds with pleiotropic mechanisms of action, have proven effective in slowing functional decline and disease progression in IPF patients with mild to moderate functional impairment, highlighting the importance of timely diagnosis and administration of treatment in early stages of disease. However, due to the complexity and uncertainties intrinsic to IPF, it is essential that each therapeutic strategy be tailored to the individual patient, after evaluation of potential benefits and risks. This article provides an overview of the most recent clinical trials in IPF and discusses how their results are going to change the clinical and clinical research landscape in IPF. A number of agents with high potential are currently being tested and many more are ready for clinical trials. Their completion is critical for achieving the ultimate goal of curing patients with IPF.
authors.affiliation: Medical University Clinic, Canton Hospital Baselland, Liestal, Switzerland; University of Basel, Liestal, Switzerland. Electronic address: paolo.spagnolo@ksbl.ch.
authors.forename: P
authors.initials: P
authors.lastname: Spagnolo
authors.affiliation: National Institute for Health Research Biological Research Unit, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom.
authors.forename: T M
authors.initials: TM
authors.lastname: Maher
authors.affiliation: National Institute for Health Research, Southampton Respiratory Biomedical Research Unit, University of Southampton, Southampton, United Kingdom.
authors.forename: L
authors.initials: L
authors.lastname: Richeldi
mesh_terms: D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000175:diagnosis / Q000188:drug therapy*; D007211:Indoles / Q000627:therapeutic use*; D011728:Pyridones / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic / Q000379:methods
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007211:Indoles; D011728:Pyridones; C093844:pirfenidone; C530716:nintedanib
keywords: Clinical trials; Idiopathic pulmonary fibrosis; Nintedanib; Pirfenidone; Therapy; Treatment