Preoperative pirfenidone cuts risk of postoperative complications in IPF patients

Preoperative treatment with pirfenidone results in a significant reduction in the risk of postoperative severe respiratory complications in patients with idiopathic pulmonary fibrosis (IPF), a study has shown.

“Preoperative pirfenidone may thus be useful in preventing postoperative severe respiratory complications in patients with IPF who are planning to undergo surgery with general anaesthesia,” the authors said.

Patients with IPF who underwent surgery with general anaesthesia from July 2010 to March 2018 were identified using the Diagnosis Procedure Combination database.

The authors then compared the occurrence of postoperative severe respiratory complications (receiving mechanical ventilation under endotracheal intubation and/or intravenous infusion of a high-dose corticosteroid and in-hospital death within 30 days after surgery) between patients who did and did not receive preoperative treatment with pirfenidone.

Finally, they conducted Pearson’s chi-square test and logistic regression analysis fitted with a generalized estimating equation in 1:4 propensity score-matched patients.

A total of 631 patients were included, of whom 19 percent received pirfenidone prior to surgery. The 30-day mortality rate was 3.1 in the control patients (n=510) and 1.7 in the pirfenidone-treated patients (n=121). In the propensity score-matched population, preoperative treatment with pirfenidone resulted in a much lower proportion of postoperative severe respiratory complications (odds ratio, 0.24, 95 percent confidence interval, 0.07–0.76; p=0.015).

“Patients with IPF often develop postoperative severe respiratory complications such as acute exacerbation,” the authors said. “Pirfenidone, an oral antifibrotic drug, may reduce the incidence of such complications.”