Rare lung & airway condition
Antifibrotic therapy: pirfenidone and nintedanib
Pirfenidone and nintedanib are the two licensed antifibrotic drugs for pulmonary fibrosis in the UK - they slow scarring rather than reverse it, and knowing their practicalities helps patients get the most from them.
Key points
The essentials at a glance.
What to look out for, how the diagnosis is confirmed, who looks after it, and the options that exist.
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Both drugs roughly halve the average rate of lung function decline in IPF; nintedanib is also licensed for other progressive fibrosing ILDs and systemic sclerosis ILD.
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They are initiated by specialist ILD centres within NICE criteria.
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Pirfenidone's main side effects are nausea, appetite loss and marked photosensitivity - rigorous sun protection is essential.
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Nintedanib's signature side effect is diarrhoea, usually manageable with dose adjustment and loperamide.
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Liver blood tests are monitored on both; neither drug improves symptoms day to day, so persistence needs realistic expectations.
Understanding it
What it is, and what happens next.
In plain English - what is going on, how specialists confirm it, and the routes to treatment in the UK.
Antifibrotics changed pulmonary fibrosis from an untreatable diagnosis to a manageable one - modestly but meaningfully. Neither pirfenidone nor nintedanib repairs scarred lung; both interfere with the fibrotic cascade to slow further loss, an effect measured in preserved lung function and, in pooled analyses, better survival. Because benefit is preventive rather than felt, side effects loom large in real-world use.
Success is mostly about staying on therapy: proactive management of nausea, sun protection or diarrhoea, dose titration rather than abandonment, and regular liver monitoring through the specialist ILD service; patients whose disease progresses on one agent are increasingly considered for a switch or for clinical trials of the next generation of antifibrotics. In many parts of the UK, routine NHS outpatient referrals for problems like this can take several months, whereas an initial appointment with a private consultant is typically available within around two weeks.
A quiet reminder
This guide is for information, not medical advice.
Your GP or specialist knows your history and can tell you which parts apply to you. If in doubt, speak to them.
Published 2026-09-27 · Next review 2027-09-27
Frequently asked
Common questions about Antifibrotic therapy: pirfenidone and nintedanib.
Quick, plain-English answers to what people ask us most.
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What is antifibrotic therapy (pirfenidone and nintedanib)?
Antifibrotic therapy refers to medications, specifically pirfenidone and nintedanib, used to slow the progression of certain lung scarring conditions such as idiopathic pulmonary fibrosis by reducing the rate of fibrotic tissue formation.
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How do pirfenidone and nintedanib work?
Both medications work through different mechanisms to reduce the processes that drive lung scarring (fibrosis), aiming to slow the decline in lung function over time rather than reversing existing scarring.
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Who is antifibrotic therapy suitable for?
These medications are typically prescribed for people with idiopathic pulmonary fibrosis and, increasingly, other progressive fibrotic lung diseases, based on specific diagnostic and lung function criteria.
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What are the side effects of antifibrotic therapy?
Common side effects include gastrointestinal symptoms such as nausea and diarrhoea, and for pirfenidone specifically, skin sensitivity to sunlight; both require monitoring of liver function during treatment.
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How effective is antifibrotic therapy?
Both medications have been shown in clinical trials to slow the rate of lung function decline, though they don't reverse existing scarring or cure the underlying condition.
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How is antifibrotic therapy monitored?
Monitoring typically includes regular liver function blood tests, lung function tests to assess disease progression, and review of side effects to guide any dose adjustments needed.
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Pirfenidone vs nintedanib — what's the difference?
Both are effective antifibrotic treatments with similar overall benefit in slowing lung function decline, but they work through different mechanisms and have somewhat different side effect profiles, so the choice often depends on individual tolerability and specific patient factors.
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How long is antifibrotic therapy taken for?
Treatment is generally continued long-term as long as it's tolerated and appears to be providing benefit, since these medications work by ongoing suppression of fibrotic processes rather than a fixed treatment course.
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Does antifibrotic therapy cure pulmonary fibrosis?
No, it does not cure the condition or reverse existing scarring, but it can meaningfully slow disease progression, which is why treatment is usually recommended as early as appropriate after diagnosis.
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When should I discuss antifibrotic therapy, and how quickly can I be seen privately?
Discuss this with a respiratory specialist following a diagnosis of pulmonary fibrosis. NHS respiratory referral can take several weeks, while private specialist assessment is often available within about two weeks.