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      Correction: Pirfenidone for Idiopathic Pulmonary Fibrosis: A Systematic Review and Meta-Analysis

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          Abstract

          There are errors in the ninth and tenth sentences of the Abstract. These sentences should read: Also there was a decrease in the risk of progression (RR of PFS: 0.82 IC 0.73–0.92) compared to placebo. Conclusions: We observed significant differences in physiologic and clinically relevant outcomes such as reduction in all-cause mortality, IPF related mortality, worsening of IPF and improvement of PFS. So pirfenidone treatment should be considered not only for its benefits in pulmonary function tests but also by its clinically relevant outcomes. There are multiple errors in the Results described below. The third and fourth sentences of the “Progression-free Survival (PFS)” section should read: The meta-analysis includes 786 patients in intervention group and 728 in placebo group (Fig 5). Pirfenidone decreased the risk of progression (RR of PFS: 0.82 IC 0.73–0.92, I2:22%) compared to placebo. We rated the quality of evidence as moderate, because of indirectness. The third sentence of the “Worsening of IPF” section should read: The meta-analysis includes 858 patients in intervention group and 763 in placebo group (Fig 7). Pirfenidone improves worsening of IPF with a RR of 0.64 (IC 0.50–0.83, I2:23%) compared to placebo. The second sentence of the “Adverse events” section should read: The meta-analysis includes 859 patients in intervention group and 763 in placebo group (Fig 10). There is an error in the third sentence of the fourth paragraph of the Discussion. It should read: We also observed differences in clinically relevant outcomes such as reduction in all-cause mortality, IPF related mortality, worsening of IPF and risk of progression; but no benefit on acute exacerbation of IPF. There are errors in the fourth and fifth columns of Table 2. Please see the corrected Table 2 here. 10.1371/journal.pone.0140288.t001 Table 2 Summary of finding form Pirfenidone for idiopathic pulmonary fibrosis. 1: Non primary outcome from RCTs, 2: High heterogeneity; 6MWT: Six minutes walk test; RCT: Randomized controlled trial; RR: Risk ratio; CI: confidence interval Outcomes Anticipate absolute effects (Study population) (95% CI) Relative Effect NO of participants Quality of the evidence (GRADE) Risk with placebo Risk with Pirfenidone All cause-mortality 67 per 1000 36 per 1000 (22 to 59) RR 0.53 (0.32 to 0.88) 1247 (3 RCTs) ⨁⨁⨁◯MODERATE1 Progression free-survival 442 per 1000 372 per 1000 (332 to 416) RR 0.82 (0.73 to 0.92) 1514 (4 RCTs) ⨁⨁⨁◯MODERATE1 Acute exacerbation 26 per 1000 15 per 1000 (5 to 47) RR 0.59 (0.19 to 1.84) 374 (2 RCTs) ⨁⨁◯◯LOW1,2 Worsening of IPF 168 per 1000 107 per 1000 (84 to 139) RR 0.64 (0.50 to 0.83) 1621 (5 RCTs) ⨁⨁⨁◯MODERATE1 Change on 6MWT 417 per 1000 308 per 1000 (267 to 358) RR 0.74 (0.64 to 0.86) 1236 (3 RCTs) ⨁⨁⨁⨁HIGH Change on aminotransferases 30 per 1000 68 per 1000 (40 to 115) RR 2.26 (1.33 to 3.83) 1621 (5 RCTs) ⨁⨁⨁◯MODERATE1 Fig 5 and its caption are incorrect. Please view Fig 5 and see its complete, correct caption here. 10.1371/journal.pone.0140288.g001 Fig 5 Comparison 3. Risk of progression (RR of PFS).

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          Pirfenidone for Idiopathic Pulmonary Fibrosis: A Systematic Review and Meta-Analysis

          Idiopathic pulmonary fibrosis (IPF) is a progressive disease with poor prognosis. In the last decades pirfenidone an anti-inflammatory and anti-fibrotic agent has shown benefit in inhibit collagen production and has also demonstrated benefit in decline progression in IPF in physiological outcomes as Forced vital capacity (FVC), in clinical outcomes such as progression free survival (PFS) and a benefit in mortality but no in clinically relevant outcomes as exacerbations or worsening of IPF. Methods: We conducted a systematic review to evaluate the effectiveness of physiological and clinical outcomes of pirfenidone compared to placebo in IPF. We performed a search with no language restriction. Two researchers performed literature search, quality assessment, data extraction and analysis. And was performed a summary of findings table following the GRADE approach. Results: We included 5 RCTs (Randomized controlled trials) in analysis. The meta-analysis resulted in a decrease in all cause-mortality (RR 0.52 IC 0.32–0.88) and IPF related mortality (RR 0.32 IC 0.14–0.75); other outcomes evaluated were worsening of IPF (RR 0.64 IC 0.50–0.83) and acute exacerbation (RR: 0.72 IC 0.30–1.66 respectively). Also there was a decrease in progression free survival (PFS) (RR 0.83 IC 0.74–0.92) compared to placebo. Conclusions: We observed significant differences in physiologic and clinically relevant outcomes such as reduction in all-cause mortality, IPF related mortality, worsening and exacerbation of IPF and PFS. So pirfenidone treatment should be considered not only for its benefits in pulmonary function tests but also by its clinically relevant outcomes.
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            Author and article information

            Journal
            PLoS One
            PLoS ONE
            plos
            plosone
            PLoS ONE
            Public Library of Science (San Francisco, CA USA )
            1932-6203
            6 October 2015
            2015
            : 10
            : 10
            : e0140288
            Article
            PONE-D-15-42312
            10.1371/journal.pone.0140288
            4595022
            26439742
            1ff0c6e6-5f4e-4119-873c-a12b196a1a6e
            Copyright @ 2015

            This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

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