Effect of continued antifibrotic therapy after forced vital capacity decline in patients with idiopathic pulmonary fibrosis; a real world multicenter cohort study - 25/01/22
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Abstract |
Rationale |
Longitudinal data on the impact of continued, switched or discontinued antifibrotic therapy in patients with idiopathic pulmonary fibrosis (IPF) who have disease progression is needed.
Objective |
We hypothesized that ongoing antifibrotic use (versus discontinuation) in the setting of forced vital capacity (FVC) decline would be associated with less future decline and lower likelihood of a composite outcome of FVC decline, lung transplant, or death.
Methods |
We performed a multicenter cohort study using data from the Canadian Registry for Pulmonary Fibrosis in patients with IPF with FVC decline ≥10% over 6 months on antifibrotic therapy. The association of continued, switched or discontinued therapy with (1) further change in FVC and (2) a composite of FVC decline ≥10%, transplant, or death, in the subsequent 6 months, was assessed using adjusted linear and logistic regression modelling, respectively. Generalized estimating equations accounted for repeated observations per patient.
Results |
165 patients had a decline in FVC ≥10% over 6 months while receiving antifibrotic therapy. Compared to continued use, antifibrotic discontinuation after FVC decline was associated with greater additional FVC decline (−207 mL 95%CI -353 to −62, p = 0.005) and higher odds of FVC decline ≥10%, transplant, or death (odds ratio 12.2 95%CI 1.2 to 130.5, p = 0.04). There was no difference between continued versus switched antifibrotic therapy.
Conclusions |
Ongoing antifibrotic therapy in the setting of FVC decline is associated with less future FVC decline and lower odds of FVC decline ≥10%, transplant, or death in a real-world cohort of IPF.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Real world data on antifibrotic use in the setting of FVC decline is needed. |
• | Antifibrotic use after FVC decline is associated with less future FVC decline. |
• | Staying on antifibrotic decreases the odds of FVC decline, transplant, or death. |
• | A minority of patients stop antifibrotic therapy in the setting of FVC decline. |
Keywords : Antifibrotics, Idiopathic pulmonary fibrosis, Interstitial lung disease
Abbreviations : CARE-PF, CCI, CI, FVC, ILD, IPF, IQR, OR, PFT, SD
Plan
Vol 191
Article 106722- janvier 2022 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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