Three-Arm Study of the Safety and Efficacy of Pirfenidone in Patients With Idiopathic Pulmonary Fibrosis

Study Overview
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Brief Summary
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The objectives of this study are to assess the safety and efficacy of treatment with pirfenidone 2403 milligrams per day (mg/d) compared with placebo in patients with idiopathic pulmonary fibrosis (IPF), to assess the safety and efficacy of treatment with pirfenidone 1197 mg/d in patients with idiopathic pulmonary fibrosis and to characterize the pharmacokinetic disposition of pirfenidone in patients with idiopathic pulmonary fibrosis.

Detailed Description
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This is a Phase 3, randomized, double blind, placebo-controlled, three-arm, safety and efficacy study of pirfenidone in patients with idiopathic pulmonary fibrosis. Approximately 400 patients at approximately 70 centers will be randomly assigned (2:2:1) to receive either 2403 milligrams (mg) of pirfenidone, placebo equivalent, or 1197 mg of pirfenidone administered in divided doses three times per day (TID) with food. Patients will be randomized by geographic region. Patients will receive blinded study treatment from the time of randomization until the last patient randomized has been treated for 72 weeks. A Data Monitoring Committee (DMC) will periodically review safety and efficacy data to ensure patient safety. After week 72, patients who meet the Progression of Disease (POD) definition, which is a ≥ 10% absolute decrease in percent predicted FVC or a ≥ 15% absolute decrease in percent predicted carbon monoxide diffusing capacity (DLco), will be eligible to receive permitted IPF therapies in addition to their blinded study drug. Permitted IPF therapies include corticosteroids, azathioprine, cyclophosphamide and N-acetyl-cysteine (with restrictions).

Official Title
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A Randomized, Double-Blind, Placebo Controlled, Phase 3, Three-Arm Study of the Safety and Efficacy of Pirfenidone in Patients With Idiopathic Pulmonary Fibrosis

Conditions
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Idiopathic Pulmonary Fibrosis

Intervention / Treatment
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* Drug: Pirfenidone
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Primary Inclusion criteria: diagnosis of idiopathic pulmonary fibrosis 40 to 80 years of age Forced Vital Capacity greater than or equal to 50% predicted value Carbon monoxide diffusing capacity greater than or equal to 35% predicted value either Forced Vital Capacity or Carbon monoxide diffusing capacity less than or equal to 90% predicted value no improvement in past year able to walk 150 meters in 6 minutes and maintain saturation greater than or equal to 83% while on no more than 6 liters per minute (L/min) supplemental oxygen Primary Exclusion criteria: unable to undergo pulmonary function testing evidence of significant obstructive lung disease or airway hyper-responsiveness in opinion of investigator patient is expected to need and be eligible for a lung transplant within 72 weeks after randomization active infection liver disease cancer or other medical condition likely to result in death within 2 years diabetes pregnancy or lactation substance abuse personal or family history of long QT (Q wave,T wave) syndrome other IPF treatment unable to take study medication withdrawal from other IPF trials

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: 2403 mg/day pirfenidone<br>Active arm 1, 2403 mg/day pirfenidone dose group. | Drug: Pirfenidone<br>* 1197 or 2403 mg/day given orally, and administered in divided doses three times daily with food, for the duration of the study.<br>|
| Active Comparator: 1197 mg/day pirfenidone<br>Active arm 2, 1197 mg/day pirfenidone. | Drug: Pirfenidone<br>* 1197 or 2403 mg/day given orally, and administered in divided doses three times daily with food, for the duration of the study.<br>|
| Placebo Comparator: placebo<br>Placebo equivalent. | Drug: Placebo<br>* Placebo equivalent, given orally, and administered in divided doses three times daily with food, for the duration of the study.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Absolute Change in Percent Predicted Forced Vital Capacity (FVC) | Mean Change in Percent Predicted Forced Vital Capacity (FVC) as measured from baseline to week 72. | From baseline up to 72 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Categorical Assessment of Absolute Change in Percent Predicted Forced Vital Capacity (FVC) | Based on the change in baseline percent predicted FVC at week 72, patients were assigned to 1 of 5 categories: mild decline (<10% but >=0% decline), moderate decline (<20% but >=10% decline), severe decline (>=20% decline), mild improvement (>0% but <10% improvement), or moderate improvement (>=10% improvement). Those who died or had a lung transplant before Week 72 were included in the severe decline category. The results indicate the number of patients who experienced a Categorical Change in Percent Predicted Forced Vital Capacity. | baseline up to 72 weeks | 
| Progression-free Survival (PFS) | Progression is defined as the first occurrence of a 10% absolute decline from baseline in percent predicted Forced Vital Capacity, a 15% absolute decline from baseline in percent predicted hemoglobin(Hgb)-corrected carbon monoxide diffusing capacity (DLco), or, death. | Baseline to Week 72 | 
| Change in Six-Minute Walk Test (6MWT)Distance | The change from Baseline to week 72 in distance walked during the 6-Minute Walk Test as measured in meters (m). | Baseline to Week 72 | 
| Change in Worst Oxygen Saturation by Pulse Oximetry (SpO2) Measurement Observed During the 6-Minute Walk Test | The change from baseline to week 72 in worst oxygen saturation during the 6-Minute Walk Test as measure by Pulse Oximetry (SpO2) Level is calculated as the simple difference between baseline SpO2 measurements and week 72 SpO2 measurements. | Baseline to Week 72 | 
| Change in Percent Predicted Hemoglobin (Hb)-Corrected Carbon Monoxide Diffusing Capacity (DLco) of the Lungs |  | Baseline to Week 72 | 
| Change in Dyspnea Score | The mean change from baseline to week 72 in Dyspnea score was measured by the University of San Diego Shortness of Breath Questionnaire (UCSD SOBQ). The SOBQ is used to assess shortness of breath with various activities of daily living (for example, brushing ones teeth or mowing the lawn). Patients rated the severity of their shortness of breath experienced on an average day during the past week on a 6 point scale (0 to 5), with 0 = not at all breathless, 4= severely breathless and 5 = Maximally or unable to do because of breathlessness. | Baseline to Week 72 | 
| Worsening of Idiopathic Pulmonary Fibrosis (IPF) | Worsening of IPF was defined by the occurrence of any of the following events: Acute IPF exacerbation, IPF-related death, Lung transplantation, or Respiratory hospitalization. | Time to acute IPF exacerbation, IPF-related death, lung transplant or respiratory hospitalization, whichever comes first. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Idiopathic, Pulmonary, Fibrosis, Lung, Pirfenidone, InterMune