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Progressive Idiopathic Pulmonary FibrosisPhase 4PROGRESSIONNCT03939520

Management of Progressive Disease in Idiopathic Pulmonary Fibrosis

A Phase 4 study testing pirfenidone and nintedanib and pirfenidone or nintedanib in people with Progressive Idiopathic Pulmonary Fibrosis, run by Hospices Civils de Lyon at 22 sites in France.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Idiopathic pulmonary fibrosis (IPF) is a prototype of chronic, progressive, and fibrotic lung disease. It has been considered rare, with an incidence estimated to 11.5 cases per 100 000 individuals per year. Increasing rates of hospital admissions and deaths due to IPF suggest an increasing burden of disease. Read more about this study

Who is it for?
Ages 50 years and older
What is being tested?
pirfenidone and nintedanib and pirfenidone or nintedanib
Could I receive a placebo?
No, everyone receives an active treatment
How many people
279 participants
Where
22 sitesFrance
Study dates
11 Jun 2020to 9 Jan 2026
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 50 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patient aged ≥ 50 years.
  • Patient with Idiopathic Pulmonary Fibrosis satisfying the ATS/ERS/JRS/ALAT diagnostic criteria (29) diagnosed.
  • In the absence of a surgical lung biopsy, high-resolution computed tomography (HRCT) must be "consistent with Usual Interstitial Pneumonia (UIP)" defined as meeting either criteria A, B, and C, or criteria A and C, or criteria B and C below:
  • Definite honeycomb lung destruction with basal and peripheral predominance. B. Presence of reticular abnormality and traction bronchiectasis consistent with fibrosis, with basal and peripheral predominance.
  • Atypical features are absent, specifically nodules and consolidation. Ground glass opacity, if present, is less extensive than reticular opacity pattern.
  • - Patient who fulfill at least 1 of the 4 criteria for IPF progression in the 12 months (+/- one six months) before screening, despite antifibrotic treatment in clinical practice (if yes check the option(s)). These criteria are: 0 Relative decline in FVC ≥10% predicted 0 Relative decline in FVC ≥5-<10% predicted and worsened respiratory symptoms 0 Relative decline in FVC ≥5-<10% predicted and increased extent of fibrotic changes on chest imaging 0 Worsened respiratory symptoms and increased extent of fibrotic changes on chest imaging
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  • Patient must have been on a stable dose of pirfenidone or nintedanib prescribed as first-line therapy for at least 6 months, with good tolerance of 1602 to 2403 mg per day of pirfenidone or 200 to 300 mg per day of nintedanib.
  • Patient who has a FVC ≥ 45% of predicted.
  • Patient who has a forced expiratory volume in 1 second (FEV1)/FVC ratio > 0.70.
  • Patient who has a life expectancy of at least 9 months.
  • Patient who has provided his written informed consent to participate in the study.
  • Patient affiliated to a social insurance regimen.

Who cannot join

  • Patients under judicial protection.
  • Female patient who is pregnant or lactating, or is of child bearing potential (defined as a sexually mature woman not surgically sterilized or not post-menopausal for at least 24 consecutive months if ≤ 55 years or 12 months if > 55 years) and who did not agree to use highly effective methods of birth control throughout the study.
  • Patient who is currently on both pirfenidone and nintedanib.
  • Patient who has already received pirfenidone and nintedanib either concomitantly or successively.
  • Patient who has a contra-indication to pirfenidone or nintedanib.
  • Patient who has emphysema > 15% on HRCT or the extent of emphysema is greater than the extent of fibrosis according to reported results from the most recent HRCT.
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  • Patient who had acute exacerbation of idiopathic pulmonary fibrosis within the previous 3 months.
  • Patient who has a history of cigarette smoking within the previous 3 months.
  • Patient who has received experimental therapy for IPF within 4 weeks before baseline.
  • Patient who is receiving systemic corticosteroids equivalent to prednisone > 15 mg/day or equivalent within 2 weeks before baseline.
  • Patient who received Immuno-suppressants (e.g. methotrexate, azathioprine, cyclophosphamide, cyclosporine, sirolimus, everolimus or other immunosuppressants) within 4 weeks before baseline.
  • Patient who has a history of a malignancy within the previous 5 years, with the exception of basal cell skin neoplasms. In addition, a malignant diagnosis or condition first occurring prior to 5 years must be considered cured, inactive, and not under current treatment.
  • Patient who, in the Investigator's opinion, is not able to perform home spirometry in accordance with the protocol.
  • Patient who has any concurrent condition other than IPF that, in the Investigator's opinion, is unstable and/or would impact the likelihood of survival for the study duration or the subject's ability to complete the study as designed, or may influence any of the safety or efficacy assessments included in the study.
  • Patient who has baseline resting oxygen saturation of < 88% on room air or supplemental oxygen.
  • Patient who had lung transplantation or who is on a lung transplant list and the investigator anticipates the patient will not be able to complete the study prior to transplant.

Trial locations and contacts

22 sites in 1 country.

22 sites in 1 country

France22 sites
  • CHU d'Angers

    Angers

  • Centre Hospitalier de la côte Basque

    Bayonne

  • CHRU de Besançon - Hôpital Jean Minjoz

    Besançon

  • AP - HP - Hôpital Avicenne

    Bobigny

  • CHRU Hôpital Cavale Blanche

    Brest

  • Hôpital Pneumologique et Cardiovasculaire Louis Pradel

    Bron

  • CHU de Caen - Hôpital de la Côte de Nacre

    Caen

  • CHU Dijon Bourgogne - Hôpital François Mitterrand

    Dijon

  • CHRU de Lille - Hôpital Albert Calmette

    Lille

  • CHU de Marseille - Hôpital Nord

    Marseille

  • CHRU de Montpellier - Hôpital Arnaud de Villeneuve

    Montpellier

  • CHU - Hôpital G.R. Laennec

    Nantes

  • CHU de Nice, Hôpital Pasteur

    Nice

  • APHP - Hôpital Xavier Bichat-Claude Bernard

    Paris

  • Groupe Hospitalier Paris Saint Joseph

    Paris

  • CHU Poitiers

    Poitiers, 86021

  • Ch de Cornouaille

    Quimper

  • CHU Rennes - Hôpital Pontchaillou

    Rennes

  • CHU de Toulouse - Hôpital Larrey

    Toulouse

  • CHRU, Tours - Hôpital Bretonneau

    Tours

  • CHU Nancy - Hôpital Brabois

    Vandœuvre-lès-Nancy

  • Hôpital Robert Schuman

    Vantoux

Other trials in France

About this study

Official title: Pragmatic Management of Progressive Disease in Idiopathic Pulmonary Fibrosis: a Randomized Trial

Idiopathic pulmonary fibrosis (IPF) is a prototype of chronic, progressive, and fibrotic lung disease. It has been considered rare, with an incidence estimated to 11.5 cases per 100 000 individuals per year. Increasing rates of hospital admissions and deaths due to IPF suggest an increasing burden of disease. The median survival time from diagnosis is 2-4 years.

Recently two disease-modifying therapies, pirfenidone and nintedanib, have been approved worldwide. Both drugs reduce the disease progression as measured by progressive decline in forced vital capacity (FVC), with a reduction of overall mortality showed by meta-analysis of phase III pirfenidone trials.

Read more

However, progression of disease continues to occur despite the currently available drug therapy. Many patients die from progressive, chronic hypoxemic respiratory failure, or less frequently from acute exacerbation of pulmonary fibrosis. In these patients, no data are available to guide management between continuation of the prescribed antifibrotic drug, to switch to the other available antifibrotic drug, or to combine the available drugs.

The combination of nintedanib and pirfenidone is not recommended outside clinical trials. However, although both antifibrotic drugs were developed and approved as monotherapy, two recent trials have suggested the feasibility and safety of combining them over a 12-24 weeks period. These results encourage further studies of combination treatment with pirfenidone and nintedanib in patients with IPF. Such study is timely, as there is a risk that clinicians facing the continued worsening of disease in patients receiving one of the available drugs may prescribe both drugs combined outside clinical trials, potentially exposing patients to a currently unknown risk.

This study will evaluate the efficacy and tolerance of the combination pirfenidone and nintedanib as compared to a "switch monotherapy": i.e. switching from the current to the other of the two existing drugs prescribed as monotherapy, in patients who present chronic worsening IPF despite receiving either pirfenidone or nintedanib and as to a "control group": i.e.treatment still be on as before randomization (pirfenidone or nintedanib).

Being tested
pirfenidone and nintedanib, pirfenidone or nintedanib
Keywords
Pneumology, idiopathic pulmonary fibrosis, progressive disease, combined therapy, pirfenidone, nintedanib
Medical subject headings
Idiopathic Pulmonary Fibrosis, Disease Progression

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • pirfenidone and nintedanibDrug

    The experimental group will receive pirfenidone 2403 mg per day (at least 1602 mg) in combination with nintedanib 300 mg per day (at least 200 mg) during 24 weeks.

  • pirfenidone or nintedanibDrug

    The second intervention group will switch from one monotherapy during 24 weeks: with pirfenidone 2403 mg per day (at least 1602 mg) or nintedanib 300 mg per day (at least 200 mg) to the other monotherapy (nintedanib in patients who received pirfenidone as first line therapy before inclusion and conversely).

  • pirfenidone or nintedanibDrug

    The control group will keep on the same monotherapy during 24 weeks: with pirfenidone 2403 mg per day (at least 1602 mg) or nintedanib 300 mg per day (at least 200 mg) to the other monotherapy (nintedanib in patients who received pirfenidone as first line therapy before inclusion and conversely).

Study groups in NCT03939520
Study groupRoleWhat they receive
Combined therapyExperimentalNot described
Receives: Drug: pirfenidone and nintedanib
Switch monotherapyActive comparatorNot described
Receives: Drug: pirfenidone or nintedanib
Control groupOtherNot described
Receives: Drug: pirfenidone or nintedanib

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Slope of the decline in the forced vital capacity (FVC) measured by spirometry

    FVC will be measured by spirometry

    Measured: 24 weeks

Secondary outcomes (16)
  1. The proportion of patients who continue intent-to-treat therapy

    Tolerance of antifibrotic therapy at week 24, at a minimal daily dose of two thirds of the full treatment dose (e.g. 200 mg/day of nintedanib and/or 1602 mg/day of pirfenidone), with temporary interruptions of no more than 28 consecutive days.

    Measured: 24 weeks

  2. Time to permanent study drug discontinuation

    The interval from study treatment randomization to study drug permanent discontinuation or the end of follow-up. Study drug discontinuation will be considered in case of permanent termination of drug treatment allocated by randomization, transient discontinuation for longer than 28 consecutive days, or dose reduction below two thirds of the full treatment dose (i.e. 200 mg per day of nintedanib or 1602 mg per day or pirfenidone).

    Measured: 24 weeks

  3. Time to treatment failure

    The time from study treatment randomization to the first occurrence during the 24 weeks follow-up of any of the following events:

    • Death from any cause,
    • Non-elective hospitalization from pulmonary cause (which is predefined by a set of criteria in protocol),
    • Acute exacerbation of idiopathic pulmonary fibrosis (idiopathic or triggered),
    • Decrease (based on relative decline) from baseline of ≥ 10% in FVC,
    • Permanent study drug discontinuation (see above) (allcause). or the end of follow-up.

    Measured: 24 weeks

  4. Proportion of decrease ≥ 10% FVC relative decline or death

    Proportion of patients with ≥ 10% FVC relative decline or death at week 24.

    Measured: 24 weeks

  5. Hospitalization-free survival

    The time from randomization to the first occurrence during the 24 weeks follow-up of any of the following events:

    • Death from any cause,
    • All-cause unscheduled hospital admission, or the end of follow-up.

    Measured: 24 weeks

  6. Time from randomization to the first non-elective hospitalization from pulmonary cause

    Non-elective hospitalization from pulmonary cause (which is predefined by a set of criteria in protocol) during the 24 weeks follow-up or the end of follow-up.

    Measured: 24 weeks

  7. Time from randomization to death

    Time from randomization to death from any cause during the 24 weeks of the study or the end of follow-up.

    Measured: 24 weeks

  8. Progression of disease on imaging by computed tomography

    Progression of disease evaluated by the change from baseline in volume of fibrotic features at imaging by computed tomography assessed at 24 weeks.

    Measured: 24 weeks

  9. Time from randomization to initiation of supplementary oxygen therapy

    Time from randomization to initiation of supplementary oxygen therapy during the 24 weeks of the study or the end of follow-up.

    Measured: 24 weeks

  10. Time from randomization to acute exacerbation of idiopathic pulmonary fibrosis

    Time from randomization to acute exacerbation of idiopathic pulmonary fibrosis (idiopathic or triggered) during the 24 weeks of the study or the end of follow-up.

    Measured: 24 weeks

  11. Quality of live assessed by the "Analogy and Likert" scale for the evaluation of dyspnea, cough and respiratory health

    Absolute change in the "Analogy and Likert" scale relative to symptoms and impact on quality of life between baseline and week 24. The scale is between 3 and 11 points : 3 being the worst score and 11 being the best

    Measured: 24 weeks

  12. Quality of live assessed by the "Pulmonary Fibrosis (L-PF)" questionnaire

    Absolute change in Living with the "Pulmonary Fibrosis (L-PF)" questionnaire relative to symptoms and impact on quality of life between baseline and week 24.

    Measured: 24 weeks

  13. Quality of live assessed by EuroQoL 5-dimension 5-level Questionnaire

    Absolute change in EuroQoL 5-dimension 5-level (EQ-5D-5L) Questionnaire relative to symptoms and impact on quality of life between baseline and week 24. This questionnaire gives a score between 0 and 100 : 0 being the worst condition possible and 100 being the best.

    Measured: 24 weeks

  14. Quality of live assessed by King's Brief Interstitial Lung Disease Questionnaire

    Absolute change in King's Brief Interstitial Lung Disease Questionnaire (K-BILD) relative to symptoms and impact on quality of life between baseline and week 24. This questionnaire gives a score between 0 and 100 : 0 being the worst score and 100 being the best

    Measured: 24 weeks

  15. Link between CA-125 variations and disease progression, the endpoint will be the slope of the FVC (exploratory)

    For the analysis of the link between CA-125 variations and disease progression, the endpoint will be the slope of the FVC measured during 24 weeks by hospital spirometry. The CA-125 variations between baseline and 12 weeks will be categorized in two categories: increased versus stable or decreased.

    Measured: 24 weeks

  16. Link between biomarkers variations and disease progression, the endpoint will be the slope of the FVC (exploratory)

    For the analysis of the link between biomarkers variations and disease progression, the endpoint will be the slope of the FVC measured during 24 weeks by hospital spirometry. The biomarkers variations between baseline and 12 weeks will be categorized in two categories: increased versus stable or decreased. (Ancillary study)

    Measured: 24 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted6 May 2019
  2. Study start11 Jun 2020
  3. Primary completion9 Jan 2026
  4. Study completion9 Jan 2026

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
279 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03939520
Sponsor's protocol ID
69HCL19_0029
Other IDs
2024-511427-34-00, 2019-004326-19, 2019
Acronym
PROGRESSION
Status last verified
Jan 2026
First submitted
3 May 2019
Last updated
9 Feb 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing pirfenidone and nintedanib and pirfenidone or nintedanib in people with Progressive Idiopathic Pulmonary Fibrosis, run by Hospices Civils de Lyon at 22 sites in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 12 inclusion and 16 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 9 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 22 sites in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Slope of the decline in the forced vital capacity (FVC) measured by spirometry (time frame: 24 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Feb 2026.

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