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Updated: Apr 13, 2026
Unilateral Lung Volume Analysis Using Micro-CT for Enhanced Assessment of Pulmonary Fibrosis in Preclinical Models
Published on: June 20, 2025
Comparing new treatments for idiopathic pulmonary fibrosis--a network meta-analysis
Emma Loveman1, Vicky R Copley2, David A Scott3
1Effective Evidence LLP/Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, 1st Floor Epsilon House, Enterprise Road, Southampton, SO16 7NS, UK. Emma.Loveman@EffectiveEvidence.org.
Background:
The treatment landscape for idiopathic pulmonary fibrosis, a devastating lung disease, is changing. To investigate the effectiveness of treatments for idiopathic pulmonary fibrosis we undertook a systematic review, network meta-analysis and indirect comparison.
Methods:
We searched MEDLINE, EMBASE and The Cochrane library for relevant studies. Randomised controlled trials of pirfenidone, nintedanib or N-acetylcysteine were eligible. Predefined processes for selecting references, extracting data and assessing study quality were applied. Our network meta-analysis of published data used a fixed effect model. For forced vital capacity measures a standardised mean difference approach was used and converted to odds ratios for interpretation.
Results:
Of 1076 references, 67 were retrieved and 11 studies included. Studies were of reasonable size, populations were similar, and the overall quality was good. Only two treatments, pirfenidone (odds ratio 0.62, 95% credible interval 0.52, 0.74) and nintedanib (0.41, 95% credible interval 0.34, 0.51) produced a statistically significant slowing in the rate of forced vital capacity decline compared with placebo. In an indirect comparison, results indicate that nintedanib is statistically significantly better than pirfenidone in slowing forced vital capacity decline (odds ratio 0.67, 95% credible interval 0.51, 0.88). Results were stable in scenario analysis and random effects models. Indirect comparisons of mortality were not statistically significant between nintedanib and pirfenidone.
Conclusions:
Two treatments show beneficial effects and when compared indirectly nintedanib appears to have superior benefit on forced vital capacity. Limitations to indirect comparisons should be considered when interpreting these results, however, our findings can be useful to inform treatment decisions.
Insights
Nintedanib and pirfenidone slow idiopathic pulmonary fibrosis progression. Nintedanib demonstrated a statistically significant benefit over pirfenidone in improving forced vital capacity in this network meta-analysis.
Area of Science:
- Pulmonology
- Pharmacology
- Clinical Trials
Background:
- Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal lung disease.
- The treatment landscape for IPF is evolving with new therapeutic options.
- Investigating the comparative effectiveness of existing IPF treatments is crucial.
Purpose of the Study:
- To systematically review and perform a network meta-analysis of randomized controlled trials.
- To compare the efficacy of pirfenidone, nintedanib, and N-acetylcysteine in treating IPF.
- To conduct an indirect comparison of treatment effects on forced vital capacity (FVC) decline.
Main Methods:
- Systematic literature search of MEDLINE, EMBASE, and The Cochrane Library.
- Inclusion of randomized controlled trials (RCTs) evaluating pirfenidone, nintedanib, or N-acetylcysteine.
- Network meta-analysis using a fixed-effect model and standardized mean difference for FVC, converted to odds ratios.
Main Results:
- Eleven studies from 1076 references met inclusion criteria; studies were of good quality.
- Both pirfenidone and nintedanib significantly slowed FVC decline compared to placebo.
- Nintedanib showed a statistically significant advantage over pirfenidone in slowing FVC decline (OR 0.67, 95% CI 0.51–0.88).
Conclusions:
- Pirfenidone and nintedanib offer beneficial effects in managing IPF.
- Nintedanib appears to provide superior benefits in slowing FVC decline compared to pirfenidone.
- Findings can inform clinical decisions for IPF treatment, acknowledging limitations of indirect comparisons.
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