Successful and practical pirfenidone desensitization

Idiopathic pulmonary fibrosis (IPF) is a long-term and progressively worsening interstitial lung disorder with an undefined etiology and a poor prognosis.It mainly affects middle-aged and older individuals.Pirfenidone is an oral anti-fibrotic and antiinflammatory agent that was previously approved in Europe in 2011 for the treatment of IPF and in the USA in 2014 (1).In the 2015 update to the American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/Latin American Thoracic Association treatment guidelines, pirfenidone was listed as one of the only two novel agents conditionally recommended for the treatment of IPF (2).A wide range of cutaneous adverse reactions associated with pirfenidone use have been described in the literature, including maculopapular rashes, toxidermias, and drug-induced lupus.The most frequently reported reactions are photosensitivity reactions, both phototoxic and photoallergic in nature.In a case series examining skin reactions, the mean time between the initiation of pirfenidone and the onset of cutaneous manifestations was reported to be 5.5 months (3,4).When we reviewed the literature on pirfenidone desensitization, we found only two case reports.In the first case, the total desensitization process lasted 236 days, requiring the patient to visit the hospital frequently, which was considered impractical (5).In the other case report, the desensitization protocols applied on days 0 and 42 consisted of fewer than five steps, making them unsuitable for desensitization (4).Based on this, we wanted to share our own pirfenidone desensitization protocol, which is highly practical for clinical use and has been successfully implemented.