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South San Francisco, CA.), effectively managing treatment-related adverse events (AEs) may improve adherence. Due to a lack of clinical evidence and expertise, managing these AEs can be challenging for patients and physicians alike. In the absence of evidence, consensus recommendations from physicians experienced in using pirfenidone to treat IPF are beneficial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using a modified Delphi process, expert recommendations were developed by a panel of physicians experienced with using pirfenidone for IPF. Over three iterations, panelists developed and refined a series of statements on the use of pirfenidone in IPF. Their agreement on each statement was ranked using a Likert scale.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A panel of 12 physicians participated and developed a total of 286 statements on dosing and administration, special populations, drug-drug interactions, laboratory analysis, warnings and precautions, and AE management. Expert recommendations were achieved with regard to slower initial titrations and slower titrations for AEs, dosing with meal(s) or substantial meals, and adding other prescribed pharmacological agents for AEs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Until there is further clinical evidence, the resulting consensus recommendations are intended to provide direction on the practical management of IPF with pirfenidone, by encompassing a broad experience from the real world to complement data gleaned from clinical trials.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12890-020-01209-4","type":"journal-article","created":{"date-parts":[[2020,7,14]],"date-time":"2020-07-14T13:29:27Z","timestamp":1594733367000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Expert consensus on the management of adverse events and prescribing practices associated with the treatment of patients taking pirfenidone for idiopathic pulmonary fibrosis: a Delphi consensus study"],"prefix":"10.1186","volume":"20","author":[{"given":"Franck F.","family":"Rahaghi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeenat","family":"Safdar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne Whitney","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao A.","family":"de Andrade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin R.","family":"Flaherty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Kaner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher S.","family":"King","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria L.","family":"Padilla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imre","family":"Noth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Beth","family":"Scholand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Shifren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven D.","family":"Nathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,7,14]]},"reference":[{"key":"1209_CR1","unstructured":"National Heart Lung, and Blood Institute (NIH). 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ZS received support for the design and conduct of this study through an independent grant from Genentech, Inc. and is a consultant, speaker, and has received research funding from Actelion Pharmaceuticals US, Inc., Gilead Sciences, Inc., Lung Biotechnology, United Therapeutics Corporation, Bayer Corporation, Genetetech and Bohringer ingelheim. AWB is a consultant for Promedior, Genentech, and Theravance. She is on the speaker\u2019s bureau for Genentech. JAD is a consultant and received research funding (to his institution) from Genentech, and Boehringer Ingelheim. He also received research funding from GBT, Medscape, Fibrogen, and the NHLBI. KRF has received personal fees from Boehringer Ingelheim, Veracyte, Roche\/Genentech, Fibrogen; and research funds from Roche\/Genentech, Boehringer Ingelheim. RJK is a consultant for Roche-Genentech and Boehringer-Ingelheim. He is on the speaker\u2019s bureau for non-branded disease state lectures and has participated as an investigator in clinical trials for both Companies. CSK has served as a speaker for Genentech, Inc. He has also participated on a scientific advisory board for Boehringer Ingelheim Pharmaceuticals. MLP has served as Speaker Bureau Faculty (for non-branded IPF talks) from Genentech and serves as a Consultant for Boehringer Ingelheim. IN has served as a consultant for Genentech\/HLR, Boehringer Ingelheim, Immuneworks, Sanofi Aventis, Global Blood Therapeutics. He has received research funding from Genentech and Boehringer Ingelheim. MBS has served on advisory boards, and investigator clinical trials with Genentech and Boehringer Ingelheim. MBS has patents issued for Apparatus, Compositions and Methods for Assessment of Chronic Obstructive Pulmonary Disease Progression among Rapid and Slow Decline Conditions. AS is a consultant for Roche-Genentech and Bellerophon. He is on the speaker\u2019s bureau for Roche-Genentech and Boerhinger Ingelheim. SDN is a consultant for Roche-Genentech and Boerhinger Ingelheim. He is on the speaker\u2019s bureau and has also received research funding from both Companies. He is also a consultant for United Therapeutics, Bellephoron, aTyr Pharma, and Galapogos.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"191"}}