An updated safety review of the drug treatments for idiopathic pulmonary fibrosis.

INTRODUCTION The approval of antifibrotic agents nintedanib and pirfenidone revolutionized the management of idiopathic pulmonary fibrosis (IPF). These treatments showed acceptable tolerability in randomized clinical trials, however they have been associated to a spectrum of potential side effects which require careful assessment of risks and benefits in the individual patient before commencing and during antifibrotic therapy. AREAS COVERED the accrued evidence on safety of nintedanib and pirfenidone is summarized, from the first randomized clinical trials to the open-label extension studies and post-marketing clinical experiences which helped clarify the long-term tolerability of these drugs. EXPERT OPINION the data collected over the last years confirmed the comparable tolerability profile of nintedanib and pirfenidone. The physician's assessment of expected side effects may help decide the optimal first line therapy for the individual patient. Patient's counselling during treatment remains essential to manage emerging adverse events and eventually inform the decision of drug discontinuation.