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Industry payments and prescribing patterns of antifibrotic therapy for idiopathic pulmonary fibrosis in the United States
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DOI：10.1016/j.rmed.2026.108774.png)
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Abstract
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Idiopathic pulmonary fibrosis affects approximately 130,000 individuals in the United States (US). As of 2025, three antifibrotic drugs (pirfenidone, nintedanib, and nerandomilast) are approved for treatment. Physician prescribing behavior could be influenced by pharmaceutical marketing. Given their comparable efficacy and safety profiles, pharmaceutical companies market these drugs to healthcare providers and these marketing activities may be associated with physicians' prescribing patterns for antifibrotic drugs. We conducted panel data analyses examining associations between industry payments and prescribing patterns for pirfenidone and nintedanib among US physicians who frequently prescribed either pirfenidone and nintedanib. We linked two publicly accessible large databases: the Centers for Medicare and Medicaid Services' Medicare Part D claims database (prescription data) and the Open Payments Database (industry payment data). All physician prescribers who reported more than 10 claims per year for either pirfenidone and nintedanib from 2014 to 2022 were included in our analysis. Industry payments included both general payments (e.g. food and beverage, travel and accommodation fees, speaking compensation, and consulting fees) and research payments. We performed fractional logistic regression at the individual physician level, with the proportion of each drug prescribed as the outcome variable. Among 7045 eligible physicians, 66.8% received general payments for nintedanib and 65.2% for pirfenidone. Receipt of drug-specific general payments was significantly associated with higher proportions of sponsored drug prescriptions for nintedanib (OR: 2.28; 95% CI: 2.15-2.41) and pirfenidone (OR: 1.94; 95% CI: 1.84-2.06). These findings highlight potential industry influence on clinical decision-making given clinical equipoise between antifibrotic agents.
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