Combined pirfenidone, proton pump inhibitor and N-acetylcystein (PINPOINT) in IPF: Preliminary results

Aim: Pirfenidone, N-Acetylcystein (NAC) and Proton pump inhibitor (PPI) individually shown benefit in IPF. There are no data on combined use of Pirfenidone, NAC & PPI (PINPOINT) in IPF. We present tolerability and outcome of PINPOINT in IPF. Methods: 54 patients with IPF were analyzed, 30 were started on PINPOINT at time of diagnosis (Group A), 24 already diagnosed IPF who received other therapies were initiated on PINPOINT (Group B). Pirfenidone was started at 600 mg/day and titrated to maximum individual tolerated dose (maximum 1800). PPI was administrred at 40 mg/day, NAC 1800 mg/day. Acute Exacerbation was defined per AJRCCM 2007;176(7):636. Results: Mean duration between onset of symptoms to diagnosis was 8.6 months. No patient had liver enzyme derangement. Tolerability and outcome of PINPOINT therapy given in Adverse reactions in Group A- Skin rash 3, nausea/ Vomiting 4, sleep disturbance 1, burning sensation 1 & in group B skin rash 2, nausea/ vomiting 2, loose motion 1. Conclusion: PINPOINT therapy is well tolerated in IPF. It appears that patients administered PINPOINT at diagnosis might have lesser acute exacerbation of IPF.