supporting adherence to pirfenidone in patients with idiopathic pulmonary fibrosis

Conditions: Idiopathic Pulmonary Fibrosis; Pulmonary Fibrosis

Summary: idiopathic pulmonary fibrosis (ipf) is an irreversible, chronic and relentless lung disorder of unknown aetiology leading ultimately to respiratory insufficiency and death within 2-5 years after diagnosis. treatment with the anti-fibrotic drug pirfenidone slows down the disease progression and reduces the risk of acute exacerbations. unfortunately, pirfenidone represents a complex pharmacological regimen, in which patients have to take 3 tablets 3 times a day at mealtime. as for all chronically ill patients, adherence to a complex regimen might be challenging and nonadherence might reduce the full potential of pirfenidone in patients with ipf. due to extremely sparse availability of evidence on treatment adherence in the ipf population, it needs to be fully ascertained if, why, when and how many patients discontinue treatment or struggle to correctly take pirfenidone as prescribed.

idiopathic pulmonary fibrosis (ipf) is an irreversible, chronic and relentless lung disorder of unknown aetiology characterised by a progressive destruction of lung parenchyma leading ultimately to respiratory insufficiency and death within 2-5 years after diagnosis. treatment with the anti-fibrotic drug pirfenidone slows down the disease progression and reduces the risk of acute exacerbations. evidence also showed that treatment with pirfenidone should be continued lifelong to maximise outcomes even in patients who experience disease progression during therapy. unfortunately, pirfenidone represents a complex pharmacological regimen, in which patients have to take 3 tablets 3 times a day at mealtime with a titration period in the first 3 weeks (i.e. 3 times 1 tablet of 267 mg during the first week, 3 times 2 tablets during the second week, and 3 times 3 tablets a week from week 3 onwards). as for all chronically ill patients, adherence to a complex regimen might be challenging and nonadherence might reduce the full potential of pirfenidone in patients with ipf. adherence is defined as "the extent to which a person' s behaviour - taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider"(who, 2003) and encompasses three phases namely, initiation, implementation and persistence. due to extremely sparse availability of evidence on treatment adherence in the ipf population, it needs to be fully ascertained if, why, when and how many patients discontinue treatment or struggle to correctly take pirfenidone as prescribed. furthermore, the investigators also don't know what the impact is of non-adherence to pirfenidone on clinical outcomes in patients with ipf and whether good adherence is associated with a better health related quality of life.

Eligibility criteria:
inclusion criteria: * clinical diagnosis of ipf based on the 2011 ats/ers/jrs/lata diagnostic criteria * patients who will start treatment with pirfenidone * patients of 18 years or older * oral fluency in dutch or french * being able to provide written informed consent exclusion criteria: * patients not managing their medications independently (e.g. institutionalized patients, patients living in a nursing home or patients receiving homecare from a nurse). however, patients receiving help to prepare their medication from informal caregivers (i.e. family) are allowed to participate in the study. * patients not having their follow-up consultations at the university hospitals of leuven.

Keywords: therapy adherence