Clinical trial NCT02496182: Pirfenidone in the Chronic Hypersensitivity Pneumonitis Treatment
Official title: Pirfenidone in the Chronic Hypersensitivity Pneumonitis Treatment
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: PHASE2
PHASE3
Conditions: Alveolitis Extrinsic Allergic
Pulmonary Fibrosis
Lead sponsor: Grupo Medifarma, S. A. de C. V.
Sponsor class: INDUSTRY
First posted: 2015-07-14
Enrollment: 60
Sex: ALL
Minimum age (years): 40
Maximum age (years): 85
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: The Chronic Hypersensitivity Pneumonitis (HP), is an inflammatory disease who has an evolution to develop progressive interstitial fibrosis, who cause the death of the patient. Actually HP has been treated with Prednisone and occasionally with Azathioprine, but unfortunately the treatment with these drugs have not an effective result to treat the interstitial fibrosis.

Pirfenidone has been studied over the world for the treatment of Fibrotic diseases, with positive results, and due to the Pirfenidone mechanism of action has anti-inflammatory and anti-fibrotic properties, the investigators propose to evaluate the addition of Pirfenidone to the actual treatment with Prednisone and Azathioprine in the treatment of patients with Pulmonary Fibrosis secondary to a Chronic Hypersensitivity Pneumonitis.

Detailed description: The Chronic Hypersensitivity Pneumonitis (HP), is a complex syndrome due to a exaggerated immune response caused by inhalation of foreign substances, such as molds, dusts, and organic particles, causing alveoli inflammation and in the chronic forms the disease has high rate of mortality, due to the big number of patients who develop progressive interstitial fibrosis and eventually they curse with respiratory insufficiency who cause the death of the patient.

Pirfenidone has been studied over the world for the treatment of Idiophatic Pulmonary Fibrosis (IPF), disease who constitute the most aggressive of the fibrotic diseases of the lung. Additionally Pirfenidone has been showed potential results in the treatment of fibrotic diseases in other organs, as Liver, Kidney, Hearth, etc. Pirfenidone has been described as a modulator of the fibrotic process due to his action over TGF-beta and MMP´s and also has into-inflammatory actions acting over TNF-alfa and IL-1 and IL-6.

Actually HP has been treated with Prednisone and occasionally with Azathioprine, but a high number of patients will develop irreversibly to a interstitial fibrosis with pulmonary parenchyma destruction. Unfortunately the investigators have not an effective treatment for this cases. Due to the positive results obtained with Pirfenidone in the treatment of IPF and other kind of organ fibrosis, the investigators propose to evaluate the addition of Pirfenidone to the treatment with Prednisone and Azathioprine in the treatment of patients with Pulmonary Fibrosis secondary to a Chronic Hypersensitivity Pneumonitis.

Eligibility criteria: Inclusion Criteria:

* Chronic Hypersensitivity pneumonitis with recent diagnosis confirmed by HRT with or without biopsy
* Acceptation with signed informed consent

Exclusion Criteria:

* No confirmed diagnosis
* Patients with peptic ulcer
* Pregnancy or breast feeding period
* Clinical signs of active infection
* History of severe Hepatic disease
* History of severe Kidney disease, who requires some kind of dialysis
* History of inestable cardiopathy
* History of alcohol or drugs abuse
* Bronchial hyperactivity or History of asthma or EPOC
* Smoking habit 3 months before the starting or patient who decline suspend the smoking habit during the study
* Patient with impossibility to make spirometry or who can not walk
* Use of Immunosuppressants, cytotoxic agents, cytosine modulators or receptor antagonist, fluvoxamine or daily use of sildenafil.
* Patients who not accept sign the informed consent

Primary outcomes:
measure: Forced Vital Capacity (FVC)
timeFrame: 52 weeks
Secondary outcomes:
measure: High Resolution Tomography
timeFrame: 52 weeks
measure: 6 minutes walk distance test
timeFrame: 52 weeks
measure: San George Qty Score, SOBQ and EQ5D Quality Scores
timeFrame: 52 weeks
measure: Pulmonary artery systolic pressure with echocardiogram
timeFrame: 52 weeks
measure: Oxygen desaturation in exercise
timeFrame: 52 weeks
Other outcomes:
Locations:
city: Mexico city
country: Mexico
facility: Instituto Nacional de Enfermedades Respiratorias
state: Distrito Federal
Study officials:
References:
citation: Lacasse Y, Selman M, Costabel U, Dalphin JC, Ando M, Morell F, Erkinjuntti-Pekkanen R, Muller N, Colby TV, Schuyler M, Cormier Y; HP Study Group. Clinical diagnosis of hypersensitivity pneumonitis. Am J Respir Crit Care Med. 2003 Oct 15;168(8):952-8. doi: 10.1164/rccm.200301-137OC. Epub 2003 Jul 3.
citation: Selman M. Hypersensitivity pneumonitis: a multifaceted deceiving disorder. Clin Chest Med. 2004 Sep;25(3):531-47, vi. doi: 10.1016/j.ccm.2004.04.001.
citation: Gaxiola M, Buendia-Roldan I, Mejia M, Carrillo G, Estrada A, Navarro MC, Rojas-Serrano J, Selman M. Morphologic diversity of chronic pigeon breeder's disease: clinical features and survival. Respir Med. 2011 Apr;105(4):608-14. doi: 10.1016/j.rmed.2010.11.026. Epub 2010 Dec 16.
citation: Macias-Barragan J, Sandoval-Rodriguez A, Navarro-Partida J, Armendariz-Borunda J. The multifaceted role of pirfenidone and its novel targets. Fibrogenesis Tissue Repair. 2010 Sep 1;3:16. doi: 10.1186/1755-1536-3-16.
citation: Selman M, Pardo A, Richeldi L, Cerri S. Emerging drugs for idiopathic pulmonary fibrosis. Expert Opin Emerg Drugs. 2011 Jun;16(2):341-62. doi: 10.1517/14728214.2011.565049. Epub 2011 Mar 17.
citation: Schaefer CJ, Ruhrmund DW, Pan L, Seiwert SD, Kossen K. Antifibrotic activities of pirfenidone in animal models. Eur Respir Rev. 2011 Jun;20(120):85-97. doi: 10.1183/09059180.00001111.
citation: Mateos-Toledo H, Mejia-Avila M, Rodriguez-Barreto O, Mejia-Hurtado JG, Rojas-Serrano J, Estrada A, Castillo-Pedroza J, Castillo-Castillo K, Gaxiola M, Buendia-Roldan I, Selman M. An Open-label Study With Pirfenidone on Chronic Hypersensitivity Pneumonitis. Arch Bronconeumol (Engl Ed). 2020 Mar;56(3):163-169. doi: 10.1016/j.arbres.2019.08.019. Epub 2019 Nov 26. English, Spanish.