Esbriet vs Ofev (Pirfenidone Vs Nintedanib) for Pulmonary Fibrosis

The estimated number of people with Idiopathic Pulmonary Fibrosis (IPF) is about 13 to 20 out of every 100,000.

This is a specific lung disease that causes scarring in the affected areas. That leads to difficulty for oxygen to pass into the bloodstream, ultimately resulting in shortness of breath and other debilitating symptoms.

Even though there is no cure available for IPF however, there are two FDA-approved medicines named Esbriet (pirfenidone) and Ofev (nintedanib), which have shown promise in slowing the disease progression.

In order to figure out which one is better for your age group and disease specifications, this blog will provide a deep comparison of both conditions.

Basic information

Esbriet:

Esbriet is a prescription medicine used to manage a specific type of lung condition, mainly in adults. It helps to slow down the progression of certain lung issues over time.

Esbriet comes as tablets, capsules, or oral suspension, and it is typically prescribed under the guidance of a healthcare professional to be taken daily.

Like many medicines, Esbriet may have side effects, so regular check-ups with a physician are suggested to monitor its impact and adjust as needed.

The FDA approved Esbriet (pirfenidone) on October 15, 2014, for treating idiopathic pulmonary fibrosis (IPF).

Ofev:

Ofev is a prescription medication that helps slow the progression of certain lung diseases. It is commonly used for problems that involve scarring or damage to lung tissue.

The medication comes in capsule form and is typically taken twice a day. People who take Ofev often need regular check-ups with their healthcare provider to monitor how they are responding to the treatment.

Ofev may lead to some side effects, so it is important for users to stay in close contact with their doctor to manage any issues that arise during treatment.

On October 15, 2014, the FDA approved Ofev (nintedanib) as a treatment for idiopathic pulmonary fibrosis (IPF).

Efficacy of Esbriet vs. Ofev

Both medicines work effectively, but their core difference lies in their mechanism of action, which is described in detail below.

Results from a study in 2019 concluded that both pirfenidone and nintedanib worked equally well in slowing down the decrease in lung function (measured by FVC and DLCO) over 24 months, compared to people who did not receive treatment.

However, patients with more severe illnesses experienced faster worsening of their lung function even with treatment [ref].

A 2020 study found that both drugs worked similarly well in lowering death rates and slowing down the progression of the disease. They were also generally safe, with no new safety concerns found.

However, after one year, people taking nintedanib experienced a smaller decrease in DLCO (which measures lung function) compared to those on pirfenidone.

This might be due to nintedanib’s ability to slow the growth of new blood vessels (antiangiogenic effect) [ref].

Dosage and administration of Esbriet vs. Ofev

Esbriet:

The dosage of Esbriet generally follows a gradual increase over the first two weeks:

Week 1: 267 mg (1 capsule) three times a day

Week 2: 534 mg (2 capsules) three times a day

Week 3 and onward: 801 mg (3 capsules) three times a day

Note: The dose should not exceed 2,403 mg per day [ref].

Administration

Esbriet should be taken with food to reduce any chance of upsetting your stomach. Capsules should be swallowed whole, not crushed, split, or chewed. Keep doses spread evenly throughout the day (e.g., morning, midday, and evening).

Ofev:

Recommended Dose: 150 mg taken orally twice daily (approximately 12 hours apart).

For `those with tolerability issues: If side effects become severe or challenging to handle, the dose may be lowered to 100 mg taken twice a day.

Missed Dose: In case a dose is missed, it’s best to skip it and take the next one at the usual scheduled time.

Administration

To lessen the chance of stomach-related side effects, take it with food. The capsules should be swallowed whole with water, not chewed or crushed. Taking doses consistently at the same time each day is recommended to maintain stable blood levels.

Precautions: Esbriet vs. Ofev

Esbriet:

• Pirfenidone can make skin more sensitive to sunlight, so it is essential to use sunscreen and wear protective clothing outdoors.
• Liver function tests are recommended before starting Esbriet and monitored periodically during treatment.
• If a dose is missed, take it as soon as possible, but skip it if it is close to the time of the next dose. Avoid doubling up on doses.

Ofev:

• Stay well-hydrated, especially if experiencing diarrhea, as Ofev may lead to dehydration.
• Liver function tests should be monitored regularly since Ofev may affect liver enzymes.
• Consult with a healthcare provider before combining Ofev with other medications, as interactions can occur.

Mechanism of action: Esbriet vs. Ofev

Esbriet:

Even though the proper mechanism of Esbriet is not understood by scientists but research suggests that it acts through multiple pathways. 

It has anti-fibrotic effects by reducing fibroblast production, which are cells that create scar tissue in the lungs [ref].

Moreover, Esbriet has antioxidant properties, so it neutralizes harmful free radicals that can damage lung tissue and lead to fibrosis.

Its anti-inflammatory values may also help in reducing lung inflammation, which contributes to the development of IPF. This action helps slow the progression of IPF and supports lung function.

Ofev:

Apart from IPF, this drug is used in the treatment of some other fibrosing lung diseases, as well as to slow down the progression of certain types of non-small cell lung cancer.

Ofev blocks tyrosine kinases which are involved in tissue scarring, blood vessel formation, and tumor growth.

Specifically, it stops key proteins like, VEGFR, FGFR, and PDGFR to prevent any scarring. This way the progression is slowed and lung damage is reduced [ref].

Final face-off

Note: Make sure to consult your doctor to find out which medicine works best for your condition the best.