P098 Cutaneous adverse effects of pirfenidone in an Irish cohort: the role of sun protection education

Abstract

Antifibrotics such as pirfenidone are prescribed to slow the progression of idiopathic pulmonary fibrosis and progressive pulmonary fibrosis. Cutaneous adverse effects (CAEs), such as erythema, pruritus and burns, occur in 29% [95% confidence interval (CI) 26.3–31.9] of patients secondary to medication-induced photosensitivity, as per the PASSPORT Trial.

These CAEs can cause significant patient distress and therefore affect treatment adherence.

As a result, sun protection education (sun protection factor 50+, sun-protective clothing, etc.) should be emphasized to patients prior to commencing pirfenidone. Despite the frequency and presentation of pirfenidone-induced photosensitivity and CAEs being well known, there is limited research on the role of sun protection education, practice and application, and their impact on CAEs. The aim of this study was to evaluate the incidence and management of pirfenidone-associated CAEs in an Irish cohort, with particular reference to sun protection education and adherence. This was a retrospective data review of patients on pirfenidone at a single-centre Irish cohort (2018–2025). Sun protection education was delivered prior to the commencement of pirfenidone. CAEs and management methods (dose reduction, switch, discontinuation) were recoded. In total, 315 patients receiving pirfenidone were reviewed. Of these, 14 (4.4%, 95% CI 2.7–7.3) developed CAEs, including rash (93%) and pruritus (7%). Management methods for CAEs included changing antifibrotic therapy (50%), reducing the dose of pirfenidone (14%) and stopping and restarting pirfenidone (14%), all with no recurrent CAEs. Overall, 21% of patients discontinued treatment secondary to photosensitivity and CAEs, with 33.3% of these patients reporting nonadherence to sun protection. In this single-centre Irish cohort, where sun protection education is emphasized prior to antifibrotic treatment, rates of CAEs on pirfenidone (4.4%, 95% CI 2.7–7.3) were lower than international rates (29%, 95% CI 26.3–31.9). Management of CAEs in our cohort showed trends similar to those reported in the literature. The findings support early patient education on sun protection to mitigate cutaneous toxicity and improve medication adherence.