Compare Esbriet (Pirfenidone) with Alternatives for IPF Treatment

What is Esbriet and why do people use it?

Esbriet is the brand name for pirfenidone, an antifibrotic and anti-inflammatory medication approved to slow the progression of idiopathic pulmonary fibrosis (IPF). It was first approved by the FDA in 2014 and has since been used by over 100,000 patients worldwide. IPF is a serious lung disease where scar tissue builds up in the lungs over time, making it harder to breathe. Esbriet doesn’t cure IPF, but it helps reduce the rate at which lung function declines.

Most people take Esbriet as three pills a day, with meals to reduce stomach upset. Common side effects include nausea, fatigue, dizziness, skin rash, and sensitivity to sunlight. About 1 in 5 people stop taking it because side effects become too hard to manage.

Why look at alternatives to Esbriet?

Not everyone tolerates Esbriet well. Some patients report constant nausea, even after adjusting the dose. Others get severe sunburns from minimal exposure. A few find the three-times-daily schedule hard to stick with.

When Esbriet isn’t working or isn’t tolerable, doctors often consider other options. The main alternative is nintedanib, sold as Ofev. But there are also off-label drugs, clinical trials, and supportive therapies that matter just as much.

Nintedanib (Ofev): The other FDA-approved IPF drug

Nintedanib (brand name Ofev) is the only other drug approved in the U.S. and Australia for treating IPF. Like Esbriet, it slows lung function decline, but it works differently. While Esbriet targets inflammation and fibrosis through multiple pathways, nintedanib blocks specific growth factors that drive scar tissue formation.

Here’s how they compare:

Studies show both drugs are similarly effective at slowing lung function loss. But side effect profiles differ. People who get bad sunburns on Esbriet often switch to Ofev. Those who can’t handle diarrhea on Ofev may go back to Esbriet.

What about other drugs or treatments?

There are no other FDA-approved drugs for IPF besides Esbriet and Ofev. But some doctors use off-label medications in specific cases:

• Immunosuppressants like azathioprine or mycophenolate - used in the past, but now avoided because they increase infection risk and don’t improve survival.
• Antacids like omeprazole - often prescribed because many IPF patients have silent reflux, which may worsen lung damage.
• Colchicine - studied in small trials, but no strong evidence it slows IPF progression.

Some patients try supplements like N-acetylcysteine (NAC), but a large NIH trial in 2014 found it didn’t help when taken with standard care. Don’t waste money on unproven remedies.

Non-drug options: What actually helps?

Medications are just one part of managing IPF. The most important non-drug strategies are:

• Oxygen therapy - helps when blood oxygen drops below 88%. Many patients start using it during activity, then eventually at rest.
• Pulmonary rehab - structured exercise and education programs improve breathing, stamina, and quality of life. Studies show patients who complete rehab walk farther and feel less anxious.
• Smoking cessation - if you smoke, quitting is the single most effective thing you can do. Smoking doubles the rate of lung function decline.
• Lung transplant - for younger, healthier patients with advanced disease. Survival after transplant is about 50% at 5 years, but it’s the only option that can restore normal lung function.

Many patients don’t realize pulmonary rehab is covered by Medicare and most private insurers. Ask your doctor for a referral - it’s not optional, it’s essential.

When should you switch from Esbriet to Ofev?

There’s no hard rule, but most doctors consider switching if:

1. You’ve been on Esbriet for 3 months and side effects are still severe (e.g., daily nausea, rash that won’t go away).
2. Your lung function (measured by FVC or DLCO) keeps dropping despite taking the full dose.
3. You can’t stick to the dosing schedule - missing doses reduces effectiveness.

Switching isn’t a failure. It’s a smart adjustment. Some patients take Esbriet for 6 months, then switch to Ofev and do better. Others go the other way. There’s no right order - just what works for your body.

Never stop either drug suddenly. Both can cause a rapid worsening of IPF if stopped abruptly. Always taper under medical supervision.

Cost and access: What’s affordable?

In Australia, both Esbriet and Ofev are listed on the Pharmaceutical Benefits Scheme (PBS), meaning patients pay around $30 per script with a concession card, or $150 without. In the U.S., without insurance, Esbriet can cost over $10,000 a month. Many patients use patient assistance programs from the manufacturers to reduce costs.

Insurance often requires prior authorization for either drug. Some require you to try one before approving the other. If your insurer denies coverage, ask your doctor to appeal with a letter explaining why the alternative is needed.

What’s coming next? New drugs in the pipeline

Several new drugs are in late-stage trials for IPF:

• PRM-151 - a recombinant protein that helps clear scar tissue. Early results show promise in improving lung function.
• GLPG1690 - targets a protein involved in fibrosis. Phase 3 trials are ongoing.
• Anti-LOXL2 antibodies - block a key enzyme in scar formation. Still in early testing.

These aren’t available yet, but if you’re eligible, ask your pulmonologist about clinical trials. They’re often free and give access to cutting-edge treatments.

Final thoughts: No one-size-fits-all

There’s no single best drug for IPF. Esbriet and Ofev are both effective. The right choice depends on your side effects, lifestyle, and how your body responds. Some people do better on one, some on the other. A few even take both together - but only under close supervision.

What matters most is staying on treatment, avoiding triggers like smoking or infections, and staying active. Medication alone won’t save you - but combined with rehab, oxygen, and smart lifestyle choices, it gives you back control.

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