Safety and Tolerability of Pirfenidone in Acute Pancreatitis

Inclusion Criteria:

1. Patients 18 - 85 years of age

2. Admitted to hospital for AP, defined by at least 2 of the following 3:

3. amylase or lipase values, or both, that are greater than 3 times the upperlimit of normal values

4. characteristic cross-sectional imaging

5. typical upper abdominal pain- acute onset of a persistent, severe, epigastricpain often radiating to the back

6. Patients identified, approached, and consented to administer study medication orplacebo within 48 hours of diagnosis of AP.

7. Predicted to have MSAP or SAP by presence of one or more of the following criteria

8. APACHE II ≥ 8

9. Modified Glasgow or Imrie score ≥ 3

10. CRP > 150 mg/dL

11. PASS score > 140 at or within 48 hrs. of admission

12. CT or MRI imaging suggesting pancreatic and/or peri-pancreatic necrosis

Exclusion Criteria:

1. Age < 18 or > 85 years

2. Body weight > 200 kg

3. Presentation to the medical attention > 48 h after diagnosis of AP

4. Inability to recruit, randomize and start the allocated treatment within 48h ofstart of pain

5. Ongoing AP or diagnosis of AP in previous 30 days

6. Chronic pancreatitis

7. Known hypersensitivity to pirfenidone

8. AST/ALT ≥ 2 times the upper normal limit.

9. Alkaline phosphatase ≥ 2 times the upper normal limit

10. Bilirubin higher than upper normal limit

11. Moderate to severe heart failure and/or coronary heart disease (New York HeartAssociation (NYHA) Functional Class III/IV)

12. On home oxygen or home mechanical ventilation

13. Advanced liver disease

14. Paralytic ileus or significant nausea and vomiting

15. Chronic Diarrhea

16. Immunosuppressive disorder or on immunosuppressive medications

17. Active or advanced malignancy

18. Known cancer that is end-stage with ongoing palliative care or for which palliativecare is appropriate

19. Known established infection prior to the onset of acute pancreatitis

20. Known history of infective hepatitis

21. Known live vaccines or therapeutic infectious agents within one month of admission

22. Known pregnancy or lactation at the time of admission

23. Ongoing photosensitivity and rash

24. Women of childbearing potential who are not on oral or injectable contraceptives orIUDs and do not consent to practice abstinence for period of 4 weeks.

25. Known to be currently participating in a trial testing any investigational medicinalproduct or participation in a clinical study involving a medicinal product in thelast three months

26. Alcohol or substance abuse in the past 2 years

27. Family or personal history of long QT syndrome ( > 500 msec)

28. Medications like fluvoxamine or sildanefil

29. Significant photosensitivity or new rash

30. Renal disease with GFR < 30

31. Any condition other than above that, in the opinion of the investigator, is likelyto result in the death of the patient within the next 2 years

32. Any condition that, in the opinion of the investigator, might be significantlyexacerbated by the known side effects associated with the administration ofpirfenidone