Background Pirfenidone and Nintedanib have been approved by NICE with the aim of attenuating progression and extending the prognosis for patients with IPF. There are no indications as to which should be used first line.

Aim Because neither Pirfenidone nor Nintedanib are intended to be curative, to investigate the effects of either drug on patients’ quality of life, and to evaluate the patients’ perspectives on their use in the management of IPF as a whole.

Method 15 patients were monitored over an 8 month period, and a patient story was compiled. Forced vital capacity was monitored as an indicator of the drugs clinical efficacy (a rate of decline that did not exceed 10% in 12 months). Then the patients’ perspective on how treatment(s) affected their quality of life was evaluated; this included physical wellbeing, psychological wellbeing and any adversities associated with the drug(s). Weight was also monitored. Results were obtained through use of patient notes and verbal feedback during appointments.

Results In no case did a patient’s FVC decline greater than 10% in a 12 month period, suggesting Pirfenidone and Nintedanib were clinically effective in all cases. It was inconclusive what impact the drugs had on physical wellbeing, however both drugs improved patients’ psychological wellbeing. Pirfenidone was associated with profound weight loss, anorexia, rash, constipation, nausea, dyspepsia, migraine, cough, hypersomnia and altered taste. All patients receiving Pirfenidone experienced at least one side effect. All eight patients discontinued treatment due to adversities. Nintedanib was associated with diarrhoea, impaired liver function, weight loss, fatigue, anorexia, arrhythmia and epistaxis. 6 out of 13 patients discontinued treatment due to adversities, however other patients reported no adversities whatsoever.

Conclusions Although both drugs were considered clinically effective, Nintedanib was tolerated in the majority without impairing quality of life, indicating the benefits have the potential to outweigh its risks. However because 100% of patients discontinued Pirfenidone due to adverse effects, the question regarding whether the benefits outweigh its adversities ideally needs to be re-addressed on a larger scale. This study is therefore in favour of Nintedanib being used first line should larger studies reflect a similar outcome.