Study of Efficacy and Safety of Pirfenidone in Patients With Fibrotic Hypersensitivity Pneumonitis


Patients are being offered participation in this pirfenidone trial because They have been diagnosed with fibrotic hypersensitivity pneumonitis (FHP), a type of interstitial lung disease (ILD). This is a disease where scarring of lung tissue occurs as the result of inhaling substances called antigens. These antigens can be substances such as molds, chemicals or dust. As a result of this scarring the lungs are is not able to move oxygen into the bloodstream to reach other organs.

Currently over 1400 subjects have been treated with pirfenidone in 15 clinical trials. This drug has been approved by the Food and Drug Administration (FDA) for use in Idiopathic Pulmonary Fibrosis, a different type of ILD, but requires special permission for use in your condition. The use of pirfenidone has not been approved for the treatment of FHP. It is considered experimental treatment in this study.

Full Title of Study: “A Randomized, Double-Blind, Placebo-Controlled, Study of Efficacy and Safety of Pirfenidone in Patients With Fibrotic Hypersensitivity Pneumonitis”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Treatment
    • Masking: Double (Participant, Investigator)
  • Study Primary Completion Date: July 2020

Detailed Description

The purpose of this study is to evaluate the potential benefits and the safety of treatment with pirfenidone compared to placebo in subjects with FHP.

STUDY SUMMARY This study will include about 40 subjects at National Jewish Health. This is a "double blind study" which means neither the subject nor the study staff will know if the subject is get pirfenidone or placebo during the study. This is done to be sure that no one knows who is getting pirfenidone or placebo and the effects of the treatment can be measured objectively, without bias. Subject's that enroll in this study will have an equal chance of getting pirfenidone or placebo. The decision about which treatment the subject will receive (randomization) is made through a central organization.

Subjects in the study will receive either pirfenidone (2403 mg every day) or placebo capsules (a safe, inactive substance that will look the same as the pirfenidone capsules). Both the placebo and pirfenidone will be supplied in opaque, hard, white gelatin capsules and will be taken as 3 capsules by mouth, 3 times a day (a total of 9 capsules per day) and should be taken with food.

Subjects participate in this study, will be asked to take the capsules as prescribed every day for 52 weeks (12 months).


  • Drug: Pirfenidone
    • This is a single-center, randomized, double-blind, placebo-controlled, efficacy and safety study of pirfenidone in subjects with FHP. Approximately 40 subjects will be randomized in a 2:1 ratio to receive pirfenidone 2403 mg/d or placebo for 52 weeks.
  • Other: Placebo controlled
    • This is a single-center, randomized, double-blind, placebo-controlled, efficacy and safety study of pirfenidone in subjects with FHP. Approximately 40 subjects will be randomized in a 2:1 ratio to receive pirfenidone 2403 mg/d or placebo for 52 weeks.

Arms, Groups and Cohorts

  • Placebo Comparator: pirfenidone 2403 mg/d
    • Subjects will be randomized in a 2:1 ratio to receive either pirfenidone 2403 mg/d or a placebo equivalent.
  • Active Comparator: Placebo
    • The placebo will be visually similar to pirfenidone.

Clinical Trial Outcome Measures

Primary Measures

  • Mean change from baseline to week 52 in %FVC.
    • Time Frame: Up to 52 weeks

Secondary Measures

  • Progression-free survival (PFS) defined as the time from study treatment randomization to the first occurrence of any of the following events:
    • Time Frame: Up to 52 weeks
    • ≥5% mean change from baseline to week 52 in %FVC. Evidence of progression in fibrosis on visual comparison of baseline and week 52 HRCT scans. Acute exacerbation of FHP defined as acute respiratory declined leading to hospitalization or ER or Urgent care evaluation; or evidence of all of the following criteria within a 4-week period in the outpatient setting: Increase from baseline FIO2 ≥1 L O2. Clinically significant worsening of dyspnea and/or cough. New, superimposed ground-glass opacities or consolidation or new alveolar opacities on chest x-ray or CT. Primary: if all other causes excluded (e.g., acute gastro-esophageal aspiration, pneumothorax, infection, left heart failure, pulmonary embolism, or identifiable cause of acute lung injury). A decrease from baseline of at least 50 meters in 6-minute walk distance.

Participating in This Clinical Trial

Inclusion Criteria

1. Diagnosis of FHP, defined from the first instance in which a patient was informed of having FHP for at least 3 to 6 months.

2. Age 18 through 80 years at randomization.

3. Diagnosis of possible or definite FHP by HRCT according to pre-specified criteria (Note: HRCT scan performed within 6 month of the start of screening may be use if it meets image acquisition guidelines):

i. Definite FHP: Evidence of lung fibrosis (reticular abnormality and/or, traction bronchiectasis and/or, architectural distortion, and/or honeycombing) and one or more of the associated finding:

1. Multilobular inspiratory mosaic attenuation

2. Multilobular air trapping on expiratory images

3. Profuse centrilobular ground glass nodular opacities ii. Possible FHP: Evidence of lung fibrosis (as above) in the absence of any of above associated findings.

a. These patients are required to have a known exposure or BAL lymphocytosis or transbronchial biopsies demonstrating non-necrotizing granulomas.

FHP Disease Severity and Progression

4. FVC ≥40%, DLCO ≥30% based either on historical pulmonary function tests obtained in the 30 days prior screening or on tests obtained during screening

5. In the investigator's opinion, no evidence of improvement in measures of FHP disease severity over the preceding year.

6. Able to walk ≥100 m during the 6-minute walk test (6MWT) at Screening.

Informed Consent and Protocol Adherence

7. Able to understand and sign a written informed consent form.

8. Able to understand the importance of adherence to study treatment and the study protocol and willing to follow all study requirements, including the concomitant medication restrictions, throughout the study

Exclusion Criteria

  • Disease-Related Exclusions

1. Not a suitable candidate for enrollment or unlikely to comply with the requirements of this study, in the opinion of the investigator

2. Cigarette smoking at Screening or unwilling to avoid tobacco products throughout the study

3. Known explanation for the interstitial lung disease, including but not limited to radiation, drug toxicity, sarcoidosis, pneumoconiosis.

4. Clinical diagnosis of any connective tissue disease, including but not limited to scleroderma, polymyositis/dermatomyositis, and rheumatoid arthritis.

5. Expected to receive a lung transplant within 6 to12 months from randomization or on a lung transplant waiting list at randomization.

Medical Exclusions

6. Any condition other than FHP that, in the opinion of the investigator, is likely to result in the death of the patient within 6 to12 months.

7. Any condition that, in the opinion of the investigator, might be significantly exacerbated by the known side effects associated with the administration of pirfenidone.

8. Pregnancy or lactation. Women of childbearing capacity are required to have a negative serum pregnancy test before treatment and must agree to maintain highly effective contraception by practicing abstinence or by using at least two methods of birth control from the date of consent through the end of the study. If abstinence is not practiced, one of the two methods of birth control should be an oral contraceptive (e.g., oral contraceptive and a spermicide).

9. History of ongoing alcohol or substance abuse.

10. History of severe hepatic impairment or end-stage liver disease.

11. History of end-stage renal disease requiring dialysis.

12. Clinical evidence of active infection including, but not limited to, bronchitis, pneumonia, sinusitis, or urinary tract infection.

13. Unstable or deteriorating cardiac disease, including but not limited to the following:

1. Unstable angina pectoris or myocardial infarction.

2. Congestive heart failure requiring hospitalization.

3. Uncontrolled clinically significant arrhythmias.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 80 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • National Jewish Health
  • Collaborator
    • Genentech, Inc.
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Evans Fernandez, MD, Principal Investigator, National Jewish Health

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