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Singh R, Aggarwal D, Dutta K, Jaggi S, Sodhi MK, Saini V. Assessment of the feasibility of 1-min sit-to-stand test in evaluating functional exercise capacity in interstitial lung disease patients. J Exerc Rehabil 2023; 19:363-369. [PMID: 38188134 PMCID: PMC10766448 DOI: 10.12965/jer.2346418.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/26/2023] [Indexed: 01/09/2024] Open
Abstract
Six-min walk test (6MWT) is widely used exercise test for the evaluation of interstitial lung disease (ILD). However, the long test duration and need for long and flat surface hinder its routine use. One-min sit-to-stand test (1-STST) is devoid of such limitations, but has been scarcely evaluated. The study was conducted to evaluate the performance of 1-STST by correlating it with 6MWT in ILD patients. Stable ILD patients were prospectively enrolled. After initial spirometry, all patients performed 6MWT and 1-STST following the standard recommendations. Exercise capacity and physiological parameters (heart rate, pulse oxygen saturation, blood pressure and dyspnea [modified Borg scale]) including peripheral oxygen saturation (SpO2) were correlated after the tests using Pearson correlation, Intraclass correlation coefficient (ICC) and kappa (κ) coefficient. The results showed that the mean age of the patients (n=60) was 58.8±11.5 years (male:female=1:1). Repetitions after 1-STST showed significant correlation with 6MWT (r=0.48; P<0.001). Changes in the physiological variables were similar (P>0.05) with good consistency (ICC=0.68-0.95) between 6MWT and 1-STST. Both lowest SpO2 and difference in SpO2 also showed good agreement (ICC=0.86; 95% confidence interval [CI], 0.77-0.92 and ICC=0.68; 95% CI, 0.47-0.81 respectively) and significant correlation (r=0.76 and r=0.52, respectively). 1-STST and 6MWT were consistent in identifying patients having oxygen desaturation ≥4% (κ=0.56; 96% CI, 0.30-0.82). The results demonstrated that the performance of 1-STST was consistent with 6MWT in terms of exercise capacity and change in physiological parameters. 1-STST can be a valid alternative to 6MWT in the assessment of ILD patients, especially in peripheral health centers.
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Affiliation(s)
- Ravi Singh
- Department of Pulmonary, Critical Care and Sleep Medicine, Government Medical College and Hospital, Chandigarh,
India
| | - Deepak Aggarwal
- Department of Pulmonary, Critical Care and Sleep Medicine, Government Medical College and Hospital, Chandigarh,
India
| | - Kashish Dutta
- Department of Pulmonary, Critical Care and Sleep Medicine, Government Medical College and Hospital, Chandigarh,
India
| | - Surabhi Jaggi
- Department of Pulmonary, Critical Care and Sleep Medicine, Government Medical College and Hospital, Chandigarh,
India
| | - Mandeep Kaur Sodhi
- Department of Pulmonary, Critical Care and Sleep Medicine, Government Medical College and Hospital, Chandigarh,
India
| | - Varinder Saini
- Department of Pulmonary, Critical Care and Sleep Medicine, Government Medical College and Hospital, Chandigarh,
India
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2
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Healthcare resource use and associated costs in patients receiving pirfenidone or nintedanib for idiopathic pulmonary fibrosis. Respir Med Res 2023; 83:100951. [DOI: 10.1016/j.resmer.2022.100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/20/2022] [Accepted: 08/18/2022] [Indexed: 11/27/2022]
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3
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Yu R, Gao D, Bao J, Sun R, Cui M, Mao Y, Li K, Hu E, Zhai Y, Liu Y, Gao Y, Xiao T, Zhou H, Yang C, Xu J. Exogenous Thymosin Beta 4 Suppresses IPF-Lung Cancer in Mice: Possibly Associated with Its Inhibitory Effect on the JAK2/STAT3 Signaling Pathway. Int J Mol Sci 2023; 24:ijms24043818. [PMID: 36835236 PMCID: PMC9965428 DOI: 10.3390/ijms24043818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrotic interstitial lung disease of unknown etiology. At present, the mortality rate of the deadly disease is still very high, while the existing treatments only delay the progression of the disease and improve the quality of life of patients. Lung cancer (LC) is the most fatal disease in the world. In recent years, IPF has been considered to be an independent risk factor for the development of LC. The incidence of lung cancer is increased in the patients with IPF and the mortality is also significantly increased in the patients inflicted with the two diseases. In this study, we evaluated an animal model of pulmonary fibrosis complicated with LC by implanting LC cells orthotopically into the lungs of mice several days after bleomycin induction of the pulmonary fibrosis in the same mice. In vivo studies with the model showed that exogenous recombinant human thymosin beta 4 (exo-rhTβ4) alleviated the impairment of lung function and severity of damage of the alveolar structure by the pulmonary fibrosis and inhibited the proliferation of LC tumor growth. In addition, in vitro studies showed that exo-rhTβ4 inhibited the proliferation and migration of A549 and Mlg cells. Furthermore, our results also showed that rhTβ4 could effectively inhibit the JAK2-STAT3 signaling pathway and this might exert an anti-IPF-LC effect. The establishment of the IPF-LC animal model will be helpful for the development of drugs for the treatment of IPF-LC. Exogenous rhTβ4 can be potentially used for the treatment of IPF and LC.
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Affiliation(s)
- Rui Yu
- Institute of Biotechnology, Academy of Military Medical Sciences, Beijing 100071, China
| | - Dandi Gao
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy and Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Tianjin 300353, China
| | - Jiali Bao
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy and Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Tianjin 300353, China
| | - Ronghao Sun
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy and Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Tianjin 300353, China
| | - Mengqi Cui
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy and Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Tianjin 300353, China
| | - Yunyun Mao
- Institute of Biotechnology, Academy of Military Medical Sciences, Beijing 100071, China
| | - Kai Li
- Institute of Biotechnology, Academy of Military Medical Sciences, Beijing 100071, China
| | - Enbo Hu
- Institute of Biotechnology, Academy of Military Medical Sciences, Beijing 100071, China
| | - Yanfang Zhai
- Institute of Biotechnology, Academy of Military Medical Sciences, Beijing 100071, China
| | - Yanhong Liu
- Institute of Biotechnology, Academy of Military Medical Sciences, Beijing 100071, China
| | - Yuemei Gao
- Institute of Biotechnology, Academy of Military Medical Sciences, Beijing 100071, China
| | - Ting Xiao
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy and Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Tianjin 300353, China
| | - Honggang Zhou
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy and Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Tianjin 300353, China
| | - Cheng Yang
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy and Tianjin Key Laboratory of Molecular Drug Research, Nankai University, Tianjin 300353, China
- Correspondence: (C.Y.); (J.X.)
| | - Junjie Xu
- Institute of Biotechnology, Academy of Military Medical Sciences, Beijing 100071, China
- Correspondence: (C.Y.); (J.X.)
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4
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Li J, Yu XQ, Xie Y, Yang SG, Zhao L, Zhou M, Meng Y. Efficacy and safety of traditional Chinese medicine treatment for idiopathic pulmonary fibrosis: An exploratory, randomized, double-blinded and placebo controlled trial. Front Pharmacol 2022; 13:1053356. [PMID: 36386223 PMCID: PMC9649819 DOI: 10.3389/fphar.2022.1053356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/17/2022] [Indexed: 08/30/2023] Open
Abstract
Background and objective: Idiopathic pulmonary fibrosis (IPF) is a critical disease, with limited treatments available. Clinical practices show that traditional Chinese medicine (TCM) has certain efficacy. This study was preliminarily to evaluate the efficacy and safety of TCM treatment based on syndrome differentiation in IPF. Methods: A study design of exploratory, multi-centers, randomized, double-blinded, placebo controlled trial has been adopted. A total of 80 IPF patients from four sub-centers were enrolled. All the patients were randomly assigned into TCM group (TCMG) or control group (CG) in 1:1. Patients in TCMG were given CM granules, as patients in CG given with the placebo of CM granule. All the patients received a 26-week treatment. The efficacy was assessed by acute exacerbations (AEs) of IPF, pulmonary function, clinical symptoms, dyspnea scores (mMRC), health-related quality of life (HRQoL), 6-min walk test (6MWT) and all-cause mortality. Safety has also been assessed. Results: A total of 67 patients completed the trial with 35 in TCM group and 32 in control group. Meaningful differences have been observed in mean changes in AEs (-1.56 times; 95% CI, -2.69 to -0.43, p = 0.01), DLco% (5.29; 95% CI, 0.76 to 9.81, p = 0.02), cough scores (-0.38 points; 95% CI, -0.73 to -0.04, p = 0.03), and 6MWT (30.43 m; 95% CI, 2.85 to 58.00, p = 0.03), with no statistical differences in FEV1, FVC, expectoration, chest tightness, Shortness of breath, Fatigue, Cyanosis, mMRC, CAT, SF-36, and SGRQ total scores in 26 weeks after treatment than before treatment. At of the end of follow-up, a total of 10 patients died, including three and seven in the TCM and control group respectively. And the HR (Hazard ratio) for CM granules in all-cause mortality was 0.39 (95% CI, 0.10-1.52). The drug-related adverse events were not observed. Conclusion: CM granules, as compared with placebo, could reduce frequencies of AEs, improve pulmonary function, HRQoL, exercise capacity and symptoms and signs for IPF to some extent with acceptable side-effect.
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Affiliation(s)
- Jiansheng Li
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province and Education Ministry of China, Henan University of Chinese Medicine, Zhengzhou, Henan, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Xue-qing Yu
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province and Education Ministry of China, Henan University of Chinese Medicine, Zhengzhou, Henan, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Yang Xie
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province and Education Ministry of China, Henan University of Chinese Medicine, Zhengzhou, Henan, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Shu-guang Yang
- Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province and Education Ministry of China, Henan University of Chinese Medicine, Zhengzhou, Henan, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Limin Zhao
- Department of Respiratory Diseases, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Miao Zhou
- Department of Respiratory Diseases, The Third Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Yong Meng
- Department of Respiratory Diseases, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou, Henan, China
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5
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Górska K, Maskey-Warzęchowska M, Barnaś M, Białas A, Barczyk A, Jagielska-Len H, Jassem E, Kania A, Lewandowska K, Majewski S, Martusewicz-Boros MM, Piotrowski WJ, Siemińska A, Sładek K, Sobiecka M, Trzaska-Sobczak M, Tomkowski W, Żołnowska B, Krenke R. Therapeutic decisions in a cohort of patients with idiopathic pulmonary fibrosis: a multicenter, prospective survey from Poland. Ther Adv Chronic Dis 2022; 13:20406223221117982. [PMID: 36052286 PMCID: PMC9425901 DOI: 10.1177/20406223221117982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background Pirfenidone and nintedanib are considered as the standard of care in idiopathic pulmonary fibrosis (IPF), but there is no consensus as to which of these two agents should be regarded as first-line treatment. Objective To provide real-world data on therapeutic decisions of pulmonary specialists, particularly the choice of the antifibrotic drug in patients with IPF. Methods This was a multicenter, prospective survey collecting clinical data of patients with IPF considered as candidates for antifibrotic treatment between September 2019 and December 2020. Clinical characteristics and information on the therapeutic approach were retrieved. Statistical evaluation included multiple logistic regression analysis with stepwise model selection. Results Data on 188 patients [74.5% male, median age 73 (interquartile range, 68-78) years] considered for antifibrotic therapy were collected. Treatment was initiated in 138 patients, while 50 patients did not receive an antifibrotic, mainly due to the lack of consent for treatment and IPF severity. Seventy-two patients received pirfenidone and 66 received nintedanib. Dosing protocol (p < 0.01) and patient preference (p = 0.049) were more frequently associated with the choice of nintedanib, while comorbidity profile (p = 0.0003) and concomitant medication use (p = 0.03) were more frequently associated with the choice of pirfenidone. Age (p = 0.002), lung transfer factor for carbon monoxide (TLCO) (p = 0.001), and gastrointestinal bleeding (p = 0.03) were significantly associated with the qualification for the antifibrotic treatment. Conclusion This real-world prospective study showed that dose protocol and patient preference were more frequently associated with the choice of nintedanib, while the comorbidity profile and concomitant medication use were more frequently associated with the choice of pirfenidone. Age, TLCO, and history of gastrointestinal bleeding were significant factors influencing the decision to initiate antifibrotic therapy.
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Affiliation(s)
- Katarzyna Górska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Marta Maskey-Warzęchowska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Barnaś
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Adam Białas
- Department of Pathobiology of Respiratory Diseases, Medical University of Lodz, Lodz, Poland
| | - Adam Barczyk
- Department of Pneumonology, Medical University of Silesia, Katowice, Poland
| | - Hanna Jagielska-Len
- Clinical Department of Lung Diseases, K. Marcinkowski University Hospital, Zielona Gora, Poland
| | - Ewa Jassem
- Department of Pneumonology, Medical University of Gdańsk, Gdańsk, Poland
| | - Aleksander Kania
- Department of Pulmonology, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Lewandowska
- 1st Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | | | - Magdalena M Martusewicz-Boros
- 3rd Lung Diseases and Oncology Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | | | - Alicja Siemińska
- Department of Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Krzysztof Sładek
- Department of Pulmonology, Jagiellonian University Medical College, Kraków, Poland
| | - Małgorzata Sobiecka
- 1st Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | | | - Witold Tomkowski
- 1st Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Beata Żołnowska
- 1st Lung Diseases Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Rafał Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
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6
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Cottin V, Bonniaud P, Cadranel J, Crestani B, Jouneau S, Marchand-Adam S, Nunes H, Wémeau-Stervinou L, Bergot E, Blanchard E, Borie R, Bourdin A, Chenivesse C, Clément A, Gomez E, Gondouin A, Hirschi S, Lebargy F, Marquette CH, Montani D, Prévot G, Quetant S, Reynaud-Gaubert M, Salaun M, Sanchez O, Trumbic B, Berkani K, Brillet PY, Campana M, Chalabreysse L, Chatté G, Debieuvre D, Ferretti G, Fourrier JM, Just N, Kambouchner M, Legrand B, Le Guillou F, Lhuillier JP, Mehdaoui A, Naccache JM, Paganon C, Rémy-Jardin M, Si-Mohamed S, Terrioux P. [French practical guidelines for the diagnosis and management of IPF - 2021 update, full version]. Rev Mal Respir 2022; 39:e35-e106. [PMID: 35752506 DOI: 10.1016/j.rmr.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Since the previous French guidelines were published in 2017, substantial additional knowledge about idiopathic pulmonary fibrosis has accumulated. METHODS Under the auspices of the French-speaking Learned Society of Pulmonology and at the initiative of the coordinating reference center, practical guidelines for treatment of rare pulmonary diseases have been established. They were elaborated by groups of writers, reviewers and coordinators with the help of the OrphaLung network, as well as pulmonologists with varying practice modalities, radiologists, pathologists, a general practitioner, a head nurse, and a patients' association. The method was developed according to rules entitled "Good clinical practice" in the overall framework of the "Guidelines for clinical practice" of the official French health authority (HAS), taking into account the results of an online vote using a Likert scale. RESULTS After analysis of the literature, 54 recommendations were formulated, improved, and validated by the working groups. The recommendations covered a wide-ranging aspects of the disease and its treatment: epidemiology, diagnostic modalities, quality criteria and interpretation of chest CT, indication and modalities of lung biopsy, etiologic workup, approach to familial disease entailing indications and modalities of genetic testing, evaluation of possible functional impairments and prognosis, indications for and use of antifibrotic therapy, lung transplantation, symptom management, comorbidities and complications, treatment of chronic respiratory failure, diagnosis and management of acute exacerbations of fibrosis. CONCLUSION These evidence-based guidelines are aimed at guiding the diagnosis and the management in clinical practice of idiopathic pulmonary fibrosis.
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Affiliation(s)
- V Cottin
- Centre national coordonnateur de référence des maladies pulmonaires rares, service de pneumologie, hôpital Louis-Pradel, Hospices Civils de Lyon (HCL), Lyon, France; UMR 754, IVPC, INRAE, Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France; Membre d'OrphaLung, RespiFil, Radico-ILD2, et ERN-LUNG, Lyon, France.
| | - P Bonniaud
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie et soins intensifs respiratoires, centre hospitalo-universitaire de Bourgogne et faculté de médecine et pharmacie, université de Bourgogne-Franche Comté, Dijon ; Inserm U123-1, Dijon, France
| | - J Cadranel
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Tenon, Paris ; Sorbonne université GRC 04 Theranoscan, Paris, France
| | - B Crestani
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie A, AP-HP, hôpital Bichat, Paris, France
| | - S Jouneau
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie, hôpital Pontchaillou, Rennes ; IRSET UMR1085, université de Rennes 1, Rennes, France
| | - S Marchand-Adam
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, hôpital Bretonneau, service de pneumologie, CHRU, Tours, France
| | - H Nunes
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie, AP-HP, hôpital Avicenne, Bobigny ; université Sorbonne Paris Nord, Bobigny, France
| | - L Wémeau-Stervinou
- Centre de référence constitutif des maladies pulmonaires rares, Institut Cœur-Poumon, service de pneumologie et immuno-allergologie, CHRU de Lille, Lille, France
| | - E Bergot
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie et oncologie thoracique, hôpital Côte de Nacre, CHU de Caen, Caen, France
| | - E Blanchard
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie, hôpital Haut Levêque, CHU de Bordeaux, Pessac, France
| | - R Borie
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie A, AP-HP, hôpital Bichat, Paris, France
| | - A Bourdin
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, département de pneumologie et addictologie, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, Montpellier ; Inserm U1046, CNRS UMR 921, Montpellier, France
| | - C Chenivesse
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie et d'immuno-allergologie, hôpital Albert Calmette ; CHRU de Lille, Lille ; centre d'infection et d'immunité de Lille U1019 - UMR 9017, Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, Lille, France
| | - A Clément
- Centre de ressources et de compétence de la mucoviscidose pédiatrique, centre de référence des maladies respiratoires rares (RespiRare), service de pneumologie pédiatrique, hôpital d'enfants Armand-Trousseau, CHU Paris Est, Paris ; Sorbonne université, Paris, France
| | - E Gomez
- Centre de compétence pour les maladies pulmonaires rares, département de pneumologie, hôpitaux de Brabois, CHRU de Nancy, Vandoeuvre-les Nancy, France
| | - A Gondouin
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Jean-Minjoz, Besançon, France
| | - S Hirschi
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, Nouvel Hôpital civil, Strasbourg, France
| | - F Lebargy
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Maison Blanche, Reims, France
| | - C-H Marquette
- Centre de compétence pour les maladies pulmonaires rares, FHU OncoAge, département de pneumologie et oncologie thoracique, hôpital Pasteur, CHU de Nice, Nice cedex 1 ; Université Côte d'Azur, CNRS, Inserm, Institute of Research on Cancer and Aging (IRCAN), Nice, France
| | - D Montani
- Centre de compétence pour les maladies pulmonaires rares, centre national coordonnateur de référence de l'hypertension pulmonaire, service de pneumologie et soins intensifs pneumologiques, AP-HP, DMU 5 Thorinno, Inserm UMR S999, CHU Paris-Sud, hôpital de Bicêtre, Le Kremlin-Bicêtre ; Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre, France
| | - G Prévot
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Larrey, Toulouse, France
| | - S Quetant
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie et physiologie, CHU Grenoble Alpes, Grenoble, France
| | - M Reynaud-Gaubert
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, AP-HM, CHU Nord, Marseille ; Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - M Salaun
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, oncologie thoracique et soins intensifs respiratoires & CIC 1404, hôpital Charles Nicole, CHU de Rouen, Rouen ; IRIB, laboratoire QuantiIF-LITIS, EA 4108, université de Rouen, Rouen, France
| | - O Sanchez
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie et soins intensifs, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | | | - K Berkani
- Clinique Pierre de Soleil, Vetraz Monthoux, France
| | - P-Y Brillet
- Université Paris 13, UPRES EA 2363, Bobigny ; service de radiologie, AP-HP, hôpital Avicenne, Bobigny, France
| | - M Campana
- Service de pneumologie et oncologie thoracique, CHR Orléans, Orléans, France
| | - L Chalabreysse
- Service d'anatomie-pathologique, groupement hospitalier est, HCL, Bron, France
| | - G Chatté
- Cabinet de pneumologie et infirmerie protestante, Caluire, France
| | - D Debieuvre
- Service de pneumologie, GHRMSA, hôpital Emile-Muller, Mulhouse, France
| | - G Ferretti
- Université Grenoble Alpes, Grenoble ; service de radiologie diagnostique et interventionnelle, CHU Grenoble Alpes, Grenoble, France
| | - J-M Fourrier
- Association Pierre-Enjalran Fibrose Pulmonaire Idiopathique (APEFPI), Meyzieu, France
| | - N Just
- Service de pneumologie, CH Victor-Provo, Roubaix, France
| | - M Kambouchner
- Service de pathologie, AP-HP, hôpital Avicenne, Bobigny, France
| | - B Legrand
- Cabinet médical de la Bourgogne, Tourcoing ; Université de Lille, CHU Lille, ULR 2694 METRICS, CERIM, Lille, France
| | - F Le Guillou
- Cabinet de pneumologie, pôle santé de l'Esquirol, Le Pradet, France
| | - J-P Lhuillier
- Cabinet de pneumologie, La Varenne Saint-Hilaire, France
| | - A Mehdaoui
- Service de pneumologie et oncologie thoracique, CH Eure-Seine, Évreux, France
| | - J-M Naccache
- Service de pneumologie, allergologie et oncologie thoracique, GH Paris Saint-Joseph, Paris, France
| | - C Paganon
- Centre national coordonnateur de référence des maladies pulmonaires rares, service de pneumologie, hôpital Louis-Pradel, Hospices Civils de Lyon (HCL), Lyon, France
| | - M Rémy-Jardin
- Institut Cœur-Poumon, service de radiologie et d'imagerie thoracique, CHRU de Lille, Lille, France
| | - S Si-Mohamed
- Département d'imagerie cardiovasculaire et thoracique, hôpital Louis-Pradel, HCL, Bron ; Université de Lyon, INSA-Lyon, Université Claude-Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France
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Gastroesophageal Reflux Disease in Idiopathic Pulmonary Fibrosis: Viewer or Actor? To Treat or Not to Treat? Pharmaceuticals (Basel) 2022; 15:ph15081033. [PMID: 36015181 PMCID: PMC9412643 DOI: 10.3390/ph15081033] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/14/2022] [Accepted: 08/19/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Idiopathic pulmonary fibrosis (IPF) is a rare and severe disease with a median survival of ∼3 years. Several risk factors have been identified, such as age, genetic predisposition, tobacco exposure, and gastro-oesophageal reflux disease (GERD). Prevalence of GERD in IPF is high and may affect 87% of patients, of whom only half (47%) report symptoms. Objective: The aim of this study is to review current evidence regarding the correlation between GERD and IPF and to evaluate the current studies regarding treatments for GERD-IPF. Methods: A review to identify research papers documenting an association between GERD and IPF was performed. Results: We identified several studies that have confirmed the association between GERD and IPF, with an increased acid exposure, risk of gastric aspiration and bile acids levels in these patients. Few studies focused their attention on GERD treatment, showing how antiacid therapy was not able to change IPF evolution. Conclusions: This review investigating the correlation between GERD and IPF has confirmed the hypothesized association. However, further large prospective studies are needed to corroborate and elucidate these findings with a focus on preventative and treatment strategies.
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Cottin V, Selman M, Inoue Y, Wong AW, Corte TJ, Flaherty KR, Han MK, Jacob J, Johannson KA, Kitaichi M, Lee JS, Agusti A, Antoniou KM, Bianchi P, Caro F, Florenzano M, Galvin L, Iwasawa T, Martinez FJ, Morgan RL, Myers JL, Nicholson AG, Occhipinti M, Poletti V, Salisbury ML, Sin DD, Sverzellati N, Tonia T, Valenzuela C, Ryerson CJ, Wells AU. Syndrome of Combined Pulmonary Fibrosis and Emphysema: An Official ATS/ERS/JRS/ALAT Research Statement. Am J Respir Crit Care Med 2022; 206:e7-e41. [PMID: 35969190 PMCID: PMC7615200 DOI: 10.1164/rccm.202206-1041st] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The presence of emphysema is relatively common in patients with fibrotic interstitial lung disease. This has been designated combined pulmonary fibrosis and emphysema (CPFE). The lack of consensus over definitions and diagnostic criteria has limited CPFE research. Goals: The objectives of this task force were to review the terminology, definition, characteristics, pathophysiology, and research priorities of CPFE and to explore whether CPFE is a syndrome. Methods: This research statement was developed by a committee including 19 pulmonologists, 5 radiologists, 3 pathologists, 2 methodologists, and 2 patient representatives. The final document was supported by a focused systematic review that identified and summarized all recent publications related to CPFE. Results: This task force identified that patients with CPFE are predominantly male, with a history of smoking, severe dyspnea, relatively preserved airflow rates and lung volumes on spirometry, severely impaired DlCO, exertional hypoxemia, frequent pulmonary hypertension, and a dismal prognosis. The committee proposes to identify CPFE as a syndrome, given the clustering of pulmonary fibrosis and emphysema, shared pathogenetic pathways, unique considerations related to disease progression, increased risk of complications (pulmonary hypertension, lung cancer, and/or mortality), and implications for clinical trial design. There are varying features of interstitial lung disease and emphysema in CPFE. The committee offers a research definition and classification criteria and proposes that studies on CPFE include a comprehensive description of radiologic and, when available, pathological patterns, including some recently described patterns such as smoking-related interstitial fibrosis. Conclusions: This statement delineates the syndrome of CPFE and highlights research priorities.
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Affiliation(s)
- Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, University of Lyon, INRAE, Lyon, France
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | | | | | - Tamera J. Corte
- Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | | | | | - Joseph Jacob
- University College London, London, United Kingdom
| | - Kerri A. Johannson
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Joyce S. Lee
- University of Colorado Denver Anschutz Medical Campus, School of Medicine, Aurora, CO, USA
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain
| | - Katerina M. Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | | | - Fabian Caro
- Hospital de Rehabilitación Respiratoria "María Ferrer", Buenos Aires, Argentina
| | | | - Liam Galvin
- European idiopathic pulmonary fibrosis and related disorders federation
| | - Tae Iwasawa
- Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | | | | | | | - Andrew G. Nicholson
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | | | | | - Don D. Sin
- University of British Columbia, Vancouver, Canada
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Italy
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Claudia Valenzuela
- Pulmonology Department, Hospital Universitario de la Princesa, Departamento Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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French practical guidelines for the diagnosis and management of idiopathic pulmonary fibrosis - 2021 update. Full-length version. Respir Med Res 2022; 83:100948. [PMID: 36630775 DOI: 10.1016/j.resmer.2022.100948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Since the latest 2017 French guidelines, knowledge about idiopathic pulmonary fibrosis has evolved considerably. METHODS Practical guidelines were drafted on the initiative of the Coordinating Reference Center for Rare Pulmonary Diseases, led by the French Language Pulmonology Society (SPLF), by a coordinating group, a writing group, and a review group, with the involvement of the entire OrphaLung network, pulmonologists practicing in various settings, radiologists, pathologists, a general practitioner, a health manager, and a patient association. The method followed the "Clinical Practice Guidelines" process of the French National Authority for Health (HAS), including an online vote using a Likert scale. RESULTS After a literature review, 54 guidelines were formulated, improved, and then validated by the working groups. These guidelines addressed multiple aspects of the disease: epidemiology, diagnostic procedures, quality criteria and interpretation of chest CT scans, lung biopsy indication and procedures, etiological workup, methods and indications for family screening and genetic testing, assessment of the functional impairment and prognosis, indication and use of antifibrotic agents, lung transplantation, management of symptoms, comorbidities and complications, treatment of chronic respiratory failure, diagnosis and management of acute exacerbations of fibrosis. CONCLUSION These evidence-based guidelines are intended to guide the diagnosis and practical management of idiopathic pulmonary fibrosis.
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Fournier D, Jouneau S, Bouzille G, Polard E, Osmont MN, Scailteux LM. Real-world safety profiles of pirfenidone and nintedanib in idiopathic pulmonary fibrosis patients. Pulm Pharmacol Ther 2022; 76:102149. [PMID: 35918026 DOI: 10.1016/j.pupt.2022.102149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION While pirfenidone and nintedanib have greatly influenced the treatment of idiopathic pulmonary fibrosis (IPF), both drugs have significant early adverse drug reactions (ADRs) and almost nothing is known of their rare and delayed ADRs. We collected and analyzed pirfenidone- or nintedanib-related ADRs identified in a French rare lung disease center, recorded their profiles and identified potential safety signals. METHODS We analyzed the medical records of IPF patients treated with pirfenidone or nintedanib between January, 2011 and January, 2020 at the Rennes University Hospital to estimate the incidence of serious and non-serious ADRs cases due to each drug and the incidence of ADRs involving the cardiovascular, hepatobiliary, gastro-intestinal, dermatological, and metabolic/nutritional systems. RESULTS The 176 patients included 115 (65%) initially treated with pirfenidone and 61 (35%) given nintedanib. ADRs occurred in 78.3% of those given pirfenidone and in 70.5% of those given nintedanib. The incidence of first serious ADRs cases was about 33 per 100 person-years (100 PY) for both drugs; first non-serious pirfenidone ADRs cases were 102 per 100 PY and 130 per 100 PY for nintedanib. The incidence involving each organ system were quite similar, except for the gastro-intestinal and skin disorders. Cardiovascular disorders occurred in about 10 cases per 100 PY in both pirfenidone and nintedanib patients. DISCUSSION Most ADRs were consistent with the expected antifibrotic drug safety profiles. As arterial and venous thromboembolic events are rare, it is important to assess the risk associated with using antifibrotics by a dedicated pharmacoepidemiological study.
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Affiliation(s)
- Dorine Fournier
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Department of Clinical Pharmacology, Rennes University Hospital, 35033, Rennes, France
| | - Stéphane Jouneau
- Dept of Respiratory Medicine, Competence Center for Rare Pulmonary Diseases, CHU Rennes, University of Rennes, Rennes, France; Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail), UMR_S, 1085, Rennes, France
| | | | - Elisabeth Polard
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Department of Clinical Pharmacology, Rennes University Hospital, 35033, Rennes, France; Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail), UMR_S, 1085, Rennes, France
| | - Marie-Noëlle Osmont
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Department of Clinical Pharmacology, Rennes University Hospital, 35033, Rennes, France
| | - Lucie-Marie Scailteux
- Pharmacovigilance, Pharmacoepidemiology and Drug Information Center, Department of Clinical Pharmacology, Rennes University Hospital, 35033, Rennes, France; Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail), UMR_S, 1085, Rennes, France.
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Cottin V, Bonniaud P, Cadranel J, Jouneau S, Marchand-Adam S, Nunes H, Wémeau-Stervinou L, Crestani B. [Idiopathic pulmonary fibrosis: Update of French practical guidelines]. Rev Mal Respir 2022; 39:193-198. [PMID: 35337709 DOI: 10.1016/j.rmr.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
Affiliation(s)
- V Cottin
- Service de pneumologie, centre national coordonnateur de référence des maladies pulmonaires rares (OrphaLung), UMR 754, INRAE, hospices civils de Lyon (HCL), université Claude-Bernard Lyon 1, hôpital Louis-Pradel, Lyon, France.
| | - P Bonniaud
- Inserm U123-1, faculté de médecine et pharmacie, centre de référence constitutif des maladies pulmonaires rares, centre hospitalo-universitaire de Bourgogne, université de Bourgogne-Franche Comté, Dijon, France
| | - J Cadranel
- Centre de référence constitutif des maladies pulmonaires rares, Sorbonne université GRC 04 Theranoscan, hôpital Tenon, AP-HP, Paris, France
| | - S Jouneau
- Service de pneumologie, centre de compétence pour les maladies pulmonaires rares de l'adulte, IRSET UMR1085, université de Rennes 1, hôpital Pontchaillou, Rennes, France
| | - S Marchand-Adam
- Service de pneumologie, centre de compétence pour les maladies pulmonaires rares de l'adulte, CHRU, hôpital Bretonneau, Tours, France
| | - H Nunes
- Service de pneumologie, centre de référence constitutif des maladies pulmonaires rares, université Sorbonne Paris Nord, hôpital Avicenne, AP-HP, Bobigny, France
| | - L Wémeau-Stervinou
- Service de pneumologie et immuno-allergologie, centre de référence constitutif des maladies pulmonaires rares, institut Cœur-Poumon, CHU de Lille, Lille, France
| | - B Crestani
- Service de pneumologie A, centre de référence constitutif des maladies pulmonaires rares, université Paris Cité, hôpital Bichat, AP-HP, Paris, France
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Cottin V, Bonniaud P, Cadranel J, Crestani B, Jouneau S, Marchand-Adam S, Nunes H, Wémeau-Stervinou L, Bergot E, Blanchard E, Borie R, Bourdin A, Chenivesse C, Clément A, Gomez E, Gondouin A, Hirschi S, Lebargy F, Marquette CH, Montani D, Prévot G, Quetant S, Reynaud-Gaubert M, Salaun M, Sanchez O, Trumbic B, Berkani K, Brillet PY, Campana M, Chalabreysse L, Chatté G, Debieuvre D, Ferretti G, Fourrier JM, Just N, Kambouchner M, Legrand B, Le Guillou F, Lhuillier JP, Mehdaoui A, Naccache JM, Paganon C, Rémy-Jardin M, Si-Mohamed S, Terrioux P. [French practical guidelines for the diagnosis and management of IPF - 2021 update, short version]. Rev Mal Respir 2022; 39:275-312. [PMID: 35304014 DOI: 10.1016/j.rmr.2022.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Since the previous French guidelines were published in 2017, substantial additional knowledge about idiopathic pulmonary fibrosis has accumulated. METHODS Under the auspices of the French-speaking Learned Society of Pulmonology and at the initiative of the coordinating reference center, practical guidelines for treatment of rare pulmonary diseases have been established. They were elaborated by groups of writers, reviewers and coordinators with the help of the OrphaLung network, as well as pulmonologists with varying practice modalities, radiologists, pathologists, a general practitioner, a head nurse, and a patients' association. The method was developed according to rules entitled "Good clinical practice" in the overall framework of the "Guidelines for clinical practice" of the official French health authority (HAS), taking into account the results of an online vote using a Likert scale. RESULTS After analysis of the literature, 54 recommendations were formulated, improved, and validated by the working groups. The recommendations covered a wide-ranging aspects of the disease and its treatment: epidemiology, diagnostic modalities, quality criteria and interpretation of chest CT, indication and modalities of lung biopsy, etiologic workup, approach to familial disease entailing indications and modalities of genetic testing, evaluation of possible functional impairments and prognosis, indications for and use of antifibrotic therapy, lung transplantation, symptom management, comorbidities and complications, treatment of chronic respiratory failure, diagnosis and management of acute exacerbations of fibrosis. CONCLUSION These evidence-based guidelines are aimed at guiding the diagnosis and the management in clinical practice of idiopathic pulmonary fibrosis.
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Affiliation(s)
- V Cottin
- Centre national coordonnateur de référence des maladies pulmonaires rares, service de pneumologie, hôpital Louis-Pradel, Hospices Civils de Lyon (HCL), Lyon, France; UMR 754, IVPC, INRAE, Université de Lyon, Université Claude-Bernard Lyon 1, Lyon, France; Membre d'OrphaLung, RespiFil, Radico-ILD2, et ERN-LUNG, Lyon, France.
| | - P Bonniaud
- Service de pneumologie et soins intensifs respiratoires, centre de référence constitutif des maladies pulmonaires rares, centre hospitalo-universitaire de Bourgogne et faculté de médecine et pharmacie, université de Bourgogne-Franche Comté, Dijon ; Inserm U123-1, Dijon, France
| | - J Cadranel
- Service de pneumologie et oncologie thoracique, centre de référence constitutif des maladies pulmonaires rares, assistance publique-hôpitaux de Paris (AP-HP), hôpital Tenon, Paris ; Sorbonne université GRC 04 Theranoscan, Paris, France
| | - B Crestani
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie A, AP-HP, hôpital Bichat, Paris, France
| | - S Jouneau
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie, hôpital Pontchaillou, Rennes ; IRSET UMR1085, université de Rennes 1, Rennes, France
| | - S Marchand-Adam
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, hôpital Bretonneau, service de pneumologie, CHRU, Tours, France
| | - H Nunes
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie, AP-HP, hôpital Avicenne, Bobigny ; université Sorbonne Paris Nord, Bobigny, France
| | - L Wémeau-Stervinou
- Centre de référence constitutif des maladies pulmonaires rares, Institut Cœur-Poumon, service de pneumologie et immuno-allergologie, CHRU de Lille, Lille, France
| | - E Bergot
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie et oncologie thoracique, hôpital Côte de Nacre, CHU de Caen, Caen, France
| | - E Blanchard
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, service de pneumologie, hôpital Haut Levêque, CHU de Bordeaux, Pessac, France
| | - R Borie
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie A, AP-HP, hôpital Bichat, Paris, France
| | - A Bourdin
- Centre de compétence pour les maladies pulmonaires rares de l'adulte, département de pneumologie et addictologie, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, Montpellier ; Inserm U1046, CNRS UMR 921, Montpellier, France
| | - C Chenivesse
- Centre de référence constitutif des maladies pulmonaires rares, service de pneumologie et d'immuno-allergologie, hôpital Albert Calmette ; CHRU de Lille, Lille ; centre d'infection et d'immunité de Lille U1019 - UMR 9017, Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, Lille, France
| | - A Clément
- Centre de ressources et de compétences de la mucoviscidose pédiatrique, centre de référence des maladies respiratoires rares (RespiRare), service de pneumologie pédiatrique, hôpital d'enfants Armand-Trousseau, CHU Paris Est, Paris ; Sorbonne université, Paris, France
| | - E Gomez
- Centre de compétence pour les maladies pulmonaires rares, département de pneumologie, hôpitaux de Brabois, CHRU de Nancy, Vandoeuvre-les Nancy, France
| | - A Gondouin
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Jean Minjoz, Besançon, France
| | - S Hirschi
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, Nouvel Hôpital civil, Strasbourg, France
| | - F Lebargy
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Maison Blanche, Reims, France
| | - C-H Marquette
- Centre de compétence pour les maladies pulmonaires rares, FHU OncoAge, département de pneumologie et oncologie thoracique, hôpital Pasteur, CHU de Nice, Nice cedex 1 ; Université Côte d'Azur, CNRS, Inserm, Institute of Research on Cancer and Aging (IRCAN), Nice, France
| | - D Montani
- Centre de compétence pour les maladies pulmonaires rares, centre national coordonnateur de référence de l'hypertension pulmonaire, unité pneumologie et soins intensifs pneumologiques, AP-HP, DMU 5 Thorinno, Inserm UMR S999, CHU Paris-Sud, hôpital de Bicêtre, Le Kremlin-Bicêtre ; Université Paris-Saclay, Faculté de médecine, Le Kremlin-Bicêtre, France
| | - G Prévot
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, CHU Larrey, Toulouse, France
| | - S Quetant
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie et physiologie, CHU Grenoble Alpes, Grenoble, France
| | - M Reynaud-Gaubert
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, AP-HM, CHU Nord, Marseille ; Aix Marseille Université, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - M Salaun
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie, oncologie thoracique et soins intensifs respiratoires & CIC 1404, hôpital Charles Nicole, CHU de Rouen, Rouen ; IRIB, laboratoire QuantiIF-LITIS, EA 4108, université de Rouen, Rouen, France
| | - O Sanchez
- Centre de compétence pour les maladies pulmonaires rares, service de pneumologie et soins intensifs, hôpital européen Georges Pompidou, AP-HP, Paris, France
| | | | - K Berkani
- Clinique Pierre de Soleil, Vetraz Monthoux, France
| | - P-Y Brillet
- Université Paris 13, UPRES EA 2363, Bobigny ; service de radiologie, AP-HP, hôpital Avicenne, Bobigny, France
| | - M Campana
- Service de pneumologie et oncologie thoracique, CHR Orléans, Orléans, France
| | - L Chalabreysse
- Service d'anatomie-pathologique, groupement hospitalier est, HCL, Bron, France
| | - G Chatté
- Cabinet de pneumologie et infirmerie protestante, Caluire, France
| | - D Debieuvre
- Service de Pneumologie, GHRMSA, hôpital Emile Muller, Mulhouse, France
| | - G Ferretti
- Université Grenoble Alpes, Grenoble ; service de radiologie diagnostique et interventionnelle, CHU Grenoble Alpes, Grenoble, France
| | - J-M Fourrier
- Association Pierre Enjalran Fibrose Pulmonaire Idiopathique (APEFPI), Meyzieu, France
| | - N Just
- Service de pneumologie, CH Victor Provo, Roubaix, France
| | - M Kambouchner
- Service de pathologie, AP-HP, hôpital Avicenne, Bobigny, France
| | - B Legrand
- Cabinet médical de la Bourgogne, Tourcoing ; Université de Lille, CHU Lille, ULR 2694 METRICS, CERIM, Lille, France
| | - F Le Guillou
- Cabinet de pneumologie, pôle santé de l'Esquirol, Le Pradet, France
| | - J-P Lhuillier
- Cabinet de pneumologie, La Varenne Saint-Hilaire, France
| | - A Mehdaoui
- Service de pneumologie et oncologie thoracique, CH Eure-Seine, Évreux, France
| | - J-M Naccache
- Service de pneumologie, allergologie et oncologie thoracique, GH Paris Saint-Joseph, Paris, France
| | - C Paganon
- Centre national coordonnateur de référence des maladies pulmonaires rares, service de pneumologie, hôpital Louis-Pradel, Hospices Civils de Lyon (HCL), Lyon, France
| | - M Rémy-Jardin
- Institut Cœur-Poumon, service de radiologie et d'imagerie thoracique, CHRU de Lille, Lille, France
| | - S Si-Mohamed
- Département d'imagerie cardiovasculaire et thoracique, hôpital Louis Pradel, HCL, Bron ; Université de Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Villeurbanne, France
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Cottin V, Spagnolo P, Bonniaud P, Nolin M, Dalon F, Kirchgässler KU, Kamath TV, Van Ganse E, Belhassen M. Mortality and Respiratory-Related Hospitalizations in Idiopathic Pulmonary Fibrosis Not Treated With Antifibrotics. Front Med (Lausanne) 2022; 8:802989. [PMID: 35004781 PMCID: PMC8739228 DOI: 10.3389/fmed.2021.802989] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Real-world data regarding outcomes of idiopathic pulmonary fibrosis (IPF) are scarce, outside of registries. The claims data from the French National Health System (SNDS) were used to describe outcomes in patients diagnosed with IPF in 2015–2016 but who did not receive antifibrotic therapies. Method: Patients aged <50 years were excluded, as were patients with pulmonary fibrosis other than IPF, patients who had previously received a lung transplant, and those who had received antifibrotic therapies at any time between 2010 and 2016. Patients were followed-up until their last health record, lung transplantation, initiation of antifibrotic therapies, death, or the end of the study period (31 December 2017), whichever occurred first. Results: A total of 5,360 patients (43.2%) not treated with antifibrotic therapies were included. The mean age was 75.5 years, and 57.9% were males. In the year before inclusion, 47.3% of patients had a Charlson score ≥5. During follow-up, 41.2% of patients died. The unadjusted incidence rate was 29.9 per 100 person-years (95%CI = [28.7–31.2]), and the cumulative incidence of death at 3 years was 50.2% (95% CI = [48.3–52.1%]). In the study population, 35.3% of patients experienced an acute respiratory-related hospitalization. The unadjusted incidence rate was 32.1 per 100 person-years (95%CI = [30.6–33.5]) and the cumulative incidence of the event at 3 years was 41.5% (95% CI = [39.7–43.2%]). Interpretation: This observational study showed that, if untreated with antifibrotics, IPF is associated with a 50% all-cause mortality at 3 years. These figures can serve as a historical control of the natural course of the disease.
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Affiliation(s)
- Vincent Cottin
- National French Reference Coordinating Center for Rare Pulmonary Diseases, Louis Pradel Hospital and Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, INRAE, IVPC, ERN-LUNG, Lyon, France
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Philippe Bonniaud
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence Constitutif des Maladies Pulmonaires Rares de l'Adulte, Centre Hospitalo-Universitaire de Bourgogne and Faculté de Médecine et Pharmacie, Université de Bourgogne-Franche Comté, Dijon, France.,INSERM U123-1, Dijon, France
| | - Maëva Nolin
- PharmacoEpidemiology Lyon (PELyon), Lyon, France
| | | | | | | | - Eric Van Ganse
- PharmacoEpidemiology Lyon (PELyon), Lyon, France.,Respiratory Medicine, Croix Rousse University Hospital and Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
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Cottin V, Guéguen S, Nunes H, Jouneau S, Crestani B, Bonniaud P, Wemeau L, Israël-Biet D, Reynaud-Gaubert M, Gondouin A, Cadranel J, Marchand-Adam S, Chevereau M, Dufaure-Garé I, Amselem S, Clément A. Treatment of Idiopathic Pulmonary Fibrosis with Capsule or Tablet Formulations of Pirfenidone in the Real-Life French RaDiCo-ILD Cohort. Adv Ther 2022; 39:405-420. [PMID: 34757602 DOI: 10.1007/s12325-021-01961-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/12/2021] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Pirfenidone, an antifibrotic medication for idiopathic pulmonary fibrosis (IPF), is now available in France in two formulations: tablets since April 2018, and the initial capsules form. We conducted a cohort study to describe tolerance and acceptability of capsules and/or tablets of pirfenidone in patients with IPF. METHODS This study was nested within the French, non-randomized, multicenter RaDiCo-ILD (Rare Disease Cohort-Interstitial Lung Diseases). Included patients with IPF received at least one dose of pirfenidone tablets or capsules from July 2017 to June 2019 in three populations: the inclusion population (patients treated at least once with pirfenidone during the study period, n = 288); the potential switch population (patients treated with pirfenidone during the switch period starting April 2018, n = 256); the newly treated population (patients who initiated pirfenidone during the study period, n = 162). Each of those last two populations included three subgroups (tablets, capsules, and substitution). RESULTS In 288 patients treated, 162 newly initiated pirfenidone during the study period: there were no meaningful differences in the baseline characteristics with the 256 patients treated during the potential switch period. In the newly treated population, 30.3% started pirfenidone treatment with tablet formulation. In the potential switch population, 44.9% of patients shifted from capsule to tablet. Half of the patients shifted to tablet formulation within the first 10 months. The mean treatment duration was 21.5 months with a mean dose of 2106.7 mg/day; 46.5% of patients discontinued treatment, mainly because of adverse events. There were fewer discontinuations in the tablets and substitution subgroups than in the capsules-only subgroup. The most reported adverse event was skin rash (11.5%). No new adverse event was identified. CONCLUSIONS This real-life cohort assessing the characteristics of the prescription of pirfenidone tablets and capsules suggests a good acceptability of the tablet formulation by patients with IPF. TRIAL REGISTRATION Clinical trial registered with www.clinicaltrials.gov (NCT04238871).
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Affiliation(s)
- Vincent Cottin
- Pneumology Department, Center for Rare Pulmonary Diseases, Lyon Civil Hospices-Claude Bernard Lyon University-East Hospital Group-Louis Pradel Hospital, 59 Boulevard Pinel, Lyon, 69677, BRON Cedex, France.
| | | | - Hilario Nunes
- Pneumology Department, Avicenne University Hospital, Bobigny, France
| | - Stéphane Jouneau
- Pneumology Department, Rennes University Hospital, Rennes, France
| | - Bruno Crestani
- Pneumology Department, Paris-Bichat University Hospital, Paris, France
| | - Philippe Bonniaud
- Department of Pneumology and Thoracic Endoscopy, Dijon University Hospital, Dijon, France
| | - Lidwine Wemeau
- Pneumology Department, Lille University Hospital, Lille, France
| | - Dominique Israël-Biet
- Department of Pneumology, Intensive Care and Bronchial Endoscopies, Paris University Hospital-Georges-Pompidou European Hospital, Paris, France
| | - Martine Reynaud-Gaubert
- Department of Pneumology, Rare Respiratory Diseases, Cystic Fibrosis, Marseille University Hospital, Marseilles, France
| | - Anne Gondouin
- Pneumology Department, Besançon University Hospital, Besançon, France
| | - Jacques Cadranel
- Pneumology Department, Paris-Tenon University Hospital, Paris, France
| | | | | | | | | | - Annick Clément
- Pediatric Pneumology Department, Paris-Trousseau University Hospital, Paris, France
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Si-Mohamed SA, Nasser M, Colevray M, Nempont O, Lartaud PJ, Vlachomitrou A, Broussaud T, Ahmad K, Traclet J, Cottin V, Boussel L. Automatic quantitative computed tomography measurement of longitudinal lung volume loss in interstitial lung diseases. Eur Radiol 2022; 32:4292-4303. [PMID: 35029730 PMCID: PMC9123030 DOI: 10.1007/s00330-021-08482-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/09/2021] [Accepted: 11/24/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To compare the lung CT volume (CTvol) and pulmonary function tests in an interstitial lung disease (ILD) population. Then to evaluate the CTvol loss between idiopathic pulmonary fibrosis (IPF) and non-IPF and explore a prognostic value of annual CTvol loss in IPF. METHODS We conducted in an expert center a retrospective study between 2005 and 2018 on consecutive patients with ILD. CTvol was measured automatically using commercial software based on a deep learning algorithm. In the first group, Spearman correlation coefficients (r) between forced vital capacity (FVC), total lung capacity (TLC), and CTvol were calculated. In a second group, annual CTvol loss was calculated using linear regression analysis and compared with the Mann-Whitney test. In a last group of IPF patients, annual CTvol loss was calculated between baseline and 1-year CTs for investigating with the Youden index a prognostic value of major adverse event at 3 years. Univariate and log-rank tests were calculated. RESULTS In total, 560 patients (4610 CTs) were analyzed. For 1171 CTs, CTvol was correlated with FVC (r: 0.86) and TLC (r: 0.84) (p < 0.0001). In 408 patients (3332 CT), median annual CTvol loss was 155.7 mL in IPF versus 50.7 mL in non-IPF (p < 0.0001) over 5.03 years. In 73 IPF patients, a relative annual CTvol loss of 7.9% was associated with major adverse events (log-rank, p < 0.0001) in univariate analysis (p < 0.001). CONCLUSIONS Automated lung CT volume may be an alternative or a complementary biomarker to pulmonary function tests for the assessment of lung volume loss in ILD. KEY POINTS • There is a good correlation between lung CT volume and forced vital capacity, as well as for with total lung capacity measurements (r of 0.86 and 0.84 respectively, p < 0.0001). • Median annual CT volume loss is significantly higher in patients with idiopathic pulmonary fibrosis than in patients with other fibrotic interstitial lung diseases (155.7 versus 50.7 mL, p < 0.0001). • In idiopathic pulmonary fibrosis, a relative annual CT volume loss higher than 9.4% is associated with a significantly reduced mean survival time at 2.0 years versus 2.8 years (log-rank, p < 0.0001).
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Affiliation(s)
- Salim A. Si-Mohamed
- Radiology Department, Department of Cardiovascular and Thoracic Radiology, CHU Cardiologique Louis Pradel, Louis Pradel Hospital, 59 Boulevard Pinel, 69500 Bron, France ,University of Lyon, University Claude-Bernard Lyon 1, UJM-Saint-Étienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
| | - Mouhamad Nasser
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, INRAE, Claude Bernard University Lyon 1, Lyon, France
| | - Marion Colevray
- Radiology Department, Hôpital de La Croix-Rousse, 103 Grande rue de la Croix Rousse, 69004 Lyon, France
| | | | - Pierre-Jean Lartaud
- University of Lyon, University Claude-Bernard Lyon 1, UJM-Saint-Étienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
| | | | - Thomas Broussaud
- University of Lyon, University Claude-Bernard Lyon 1, UJM-Saint-Étienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France
| | - Kais Ahmad
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, INRAE, Claude Bernard University Lyon 1, Lyon, France
| | - Julie Traclet
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, INRAE, Claude Bernard University Lyon 1, Lyon, France
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, INRAE, Claude Bernard University Lyon 1, Lyon, France
| | - Loic Boussel
- University of Lyon, University Claude-Bernard Lyon 1, UJM-Saint-Étienne, CNRS, Inserm, CREATIS UMR 5220, U1206, 69621 Lyon, France ,Radiology Department, Hôpital de La Croix-Rousse, 103 Grande rue de la Croix Rousse, 69004 Lyon, France
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Villeneuve T, Prévot G, Lintz F, Mourin G, Ferry G, Bousquet E, Perelroizen H, Boghanim T, Faviez G, Noël-Savina E, Collot S, Le Borgne A, Didier A. [Epidemiology of fibrosing interstitial lung diseases in the department of Haute Garonne]. Rev Mal Respir 2021; 38:972-979. [PMID: 34629221 DOI: 10.1016/j.rmr.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 07/31/2021] [Indexed: 11/30/2022]
Abstract
EPIDemio study is a multicenter, prospective and observational study. The objective is to estimate the prevalence and incidence of fibrosing interstitial lung diseases (ILDs) in the department of Haute Garonne (31) in France. Fifty-five pulmonologists from the Toulouse university hospital and 8 private establishments participated in this study. Two hundred and fifty-six cases of fibrosing ILDs were reported (gross overall prevalence: 22.8/100,000 and estimated 30.1/100,000. Idiopathic ILDs represent 55.8% of fibrosing ILDs ahead of systemic disease-related ILDs (24.6%) and ILDs associated with environmental exposure (13.3%). Idiopathic pulmonary fibrosis (IPF) represents 35.9% of fibrosing ILDs, which corresponds to a minimal prevalence of 8.2/100,000 and an estimated prevalence of 11.2/100,000. This study confirms epidemiological data collected in France and Europe.
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Affiliation(s)
- T Villeneuve
- Service de pneumologie, Hôpital Larrey, Université Paul Sabatier, CHU Toulouse, Toulouse, France.
| | - G Prévot
- Service de pneumologie, Hôpital Larrey, Université Paul Sabatier, CHU Toulouse, Toulouse, France
| | - F Lintz
- Service de pneumologie, clinique Pasteur, Toulouse, France
| | - G Mourin
- Service de pneumologie, clinique d'Occitanie, Muret, France
| | - G Ferry
- Service de pneumologie, clinique des Cèdres, Cornebarrieu, France
| | - E Bousquet
- Service de pneumologie, clinique L'Union, Saint-Jean, France
| | - H Perelroizen
- Service de pneumologie, clinique La Croix du Sud, Quint-Fonsegrives, France
| | - T Boghanim
- Service de pneumologie, Hôpital Larrey, Université Paul Sabatier, CHU Toulouse, Toulouse, France
| | - G Faviez
- Service de pneumologie, Hôpital Larrey, Université Paul Sabatier, CHU Toulouse, Toulouse, France
| | - E Noël-Savina
- Service de pneumologie, Hôpital Larrey, Université Paul Sabatier, CHU Toulouse, Toulouse, France
| | - S Collot
- Service de radiologie, Hôpital Larrey-Rangueil, Université Paul-Sabatier, CHU Toulouse, Toulouse, France
| | - A Le Borgne
- Service de pneumologie, Hôpital Larrey, Université Paul Sabatier, CHU Toulouse, Toulouse, France
| | - A Didier
- Service de pneumologie, Hôpital Larrey, Université Paul Sabatier, CHU Toulouse, Toulouse, France
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Cyclophosphamide added to glucocorticoids in acute exacerbation of idiopathic pulmonary fibrosis (EXAFIP): a randomised, double-blind, placebo-controlled, phase 3 trial. THE LANCET RESPIRATORY MEDICINE 2021; 10:26-34. [PMID: 34506761 DOI: 10.1016/s2213-2600(21)00354-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/05/2021] [Accepted: 07/22/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The use of cyclophosphamide in patients with acute exacerbation of idiopathic pulmonary fibrosis (IPF) is unknown. Our study was designed to evaluate the efficacy and safety of four cyclophosphamide pulses in addition to high-dose methylprednisolone in this population. METHODS In this double-blind, placebo-controlled trial done in 35 departments across 31 hospitals in France, adult patients (≥18 years) with acute exacerbation of IPF and those with suspected acute exacerbation of IPF were randomly assigned in a 1:1 ratio using a web-based system to receive either intravenous pulses of cyclophosphamide (600 mg/m2) plus uromitexan as haemorrhagic cystitis prophylaxis (200 mg/m2) at the time of cyclophosphamide administration and then again, 4 h later, or placebo at days 0, 15, 30, and 60. Random assignment was stratified according to the severity of IPF and was block-balanced with variable block sizes of four or six patients. Patients receiving mechanical ventilation, with active infection, with active cancer, or who were registered on the lung transplant waiting list were excluded. All patients received standardised high-dose glucocorticoids. The investigators, patients, and the sponsor were masked to the treatment assignments. The primary endpoint was 3-month all-cause mortality, analysed by a χ2 test adhering to an intention-to-treat principle. The trial is now complete and registered with ClinicalTrials.gov, NCT02460588. FINDINGS Between Jan 22, 2016, and July 19, 2018, 183 patients were assessed for eligibility, of whom 120 patients were randomly assigned and 119 patients (62 [52%] with severe IPF) received at least one dose of cyclophosphamide (n=60) or placebo (n=59), all of whom were included in the intention-to-treat analysis. The 3-month all-cause mortality was 45% (27/60) in patients given cyclophosphamide compared with 31% (18/59) in the placebo group (difference 14·5% [95% CI -3·1 to 31·6]; p=0·10). Similar results were found after adjustment by IPF severity (odds ratio [OR] 1·89 [95% CI 0·89-4·04]). The risk of death at 3 months, independent of the treatment received, was higher with severe than non-severe IPF (OR 2·62 [1·12-6·12]) and was lower with the use of antifibrotic therapy (OR 0·33 [0·13-0·82]). Adverse events were similar between groups by 6 months (25 [42%] in the cyclophosphamide group vs 30 [51%] in the placebo group) and their proportion, including infections, did not differ. Overall infection was the main adverse event and occurred in 20 (33%) of 60 patients in the cyclophosphamide group versus 21 (36%) of 59 patients in the placebo group. INTERPRETATION In patients with acute exacerbation of IPF, adding intravenous cyclophosphamide pulses to glucocorticoids increased 3-month mortality. These findings provide evidence against the use of intravenous cyclophosphamide in such patients. FUNDING Programme Hospitalier de Recherche Clinique of the French Ministry of Health (PHRC 2014-502), Roche Pharmaceuticals.
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Diaz GA, Jones SA, Scarpa M, Mengel KE, Giugliani R, Guffon N, Batsu I, Fraser PA, Li J, Zhang Q, Ortemann-Renon C. One-year results of a clinical trial of olipudase alfa enzyme replacement therapy in pediatric patients with acid sphingomyelinase deficiency. Genet Med 2021; 23:1543-1550. [PMID: 33875845 PMCID: PMC8354848 DOI: 10.1038/s41436-021-01156-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To assess olipudase alfa enzyme replacement therapy for non-central nervous system manifestations of acid sphingomyelinase deficiency (ASMD) in children. METHODS This phase 1/2, international, multicenter, open-label trial (ASCEND-Peds/NCT02292654) administered intravenous olipudase alfa every 2 weeks with intrapatient dose escalation to 3 mg/kg. Primary outcome was safety through week 64. Secondary outcomes included pharmacokinetics, spleen and liver volumes, lung diffusing capacity (DLCO), lipid profiles, and height through week 52. RESULTS Twenty patients were enrolled: four adolescents (12-17 years), nine children (6-11 years), and seven infants/early child (1-5 years). Most adverse events were mild or moderate, including infusion-associated reactions (primarily urticaria, pyrexia, and/or vomiting) in 11 patients. Three patients had serious treatment-related events: one with transient asymptomatic alanine aminotransferase increases, another with urticaria and rash (antidrug antibody positive [ADA+]), and a third with an anaphylactic reaction (ADA+) who underwent desensitization and reached the 3 mg/kg maintenance dose. Mean splenomegaly and hepatomegaly improved by >40% (p < 0.0001). Mean % predicted DLCO improved by 32.9% (p = 0.0053) in patients able to perform the test. Lipid profiles and elevated liver transaminase levels normalized. Mean height Z-scores improved by 0.56 (p < 0.0001). CONCLUSION In this study in children with chronic ASMD, olipudase alfa was generally well-tolerated with significant, comprehensive improvements in disease pathology across a range of clinically relevant endpoints.
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Affiliation(s)
- George A Diaz
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Simon A Jones
- St Mary's Hospital, Manchester University Foundation Trust, University of Manchester, Manchester, UK
| | - Maurizio Scarpa
- Regional Coordinating Center for Rare Diseases, University Hospital Udine, Udine, Italy
| | | | - Roberto Giugliani
- Dept Genetics, UFRGS, Medical Genetics Clinical Research Group, HCPA, and INAGEMP, Porto Alegre, Brazil
| | - Nathalie Guffon
- Reference Center for Inherited Metabolic Disorders, Femme Mère Enfant Hospital, Lyon, France
| | | | | | - Jing Li
- Sanofi, Bridgewater, NJ, USA
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Belhassen M, Dalon F, Nolin M, Van Ganse E. Comparative outcomes in patients receiving pirfenidone or nintedanib for idiopathic pulmonary fibrosis. Respir Res 2021; 22:135. [PMID: 33947414 PMCID: PMC8094468 DOI: 10.1186/s12931-021-01714-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/13/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Real-world data regarding outcomes of idiopathic pulmonary fibrosis (IPF) are scarce, outside of registries. In France, pirfenidone and nintedanib are only reimbursed for documented IPF, with similar reimbursement criteria with respect to disease characteristics, prescription through a dedicated form, and IPF diagnosis established in multidisciplinary discussion. RESEARCH QUESTION The data of the comprehensive French National Health System were used to evaluate outcomes in patients newly treated with pirfenidone or nintedanib in 2015-2016. STUDY DESIGN AND METHODS Patients aged < 50 years or who had pulmonary fibrosis secondary to an identified cause were excluded. All-cause mortality, acute respiratory-related hospitalisations and treatment discontinuations up to 31 December 2017 were compared using a Cox proportional hazards model adjusted for age, sex, year of treatment initiation, time to treatment initiation and proxies of disease severity identified during a pre-treatment period. RESULTS During the study period, a treatment with pirfenidone or nintedanib was newly initiated in 804 and 509 patients, respectively. No difference was found between groups for age, sex, time to treatment initiation, Charlson comorbidity score, and number of hospitalisations or medical contacts prior to treatment initiation. As compared to pirfenidone, nintedanib was associated with a greater risk of all-cause mortality (hazard ratio [HR], 1.8; 95% confidence interval [CI] 1.3-2.6), a greater risk of acute respiratory-related hospitalisations (HR 1.3; 95% CI 1.0-1.7) and a lower risk of treatment discontinuation at 12 months (HR 0.7; 95% CI 0.6-0.9). INTERPRETATION This observational study identified potential differences in outcome under newly prescribed antifibrotic drugs, deserving further explorations.
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Affiliation(s)
- Manon Belhassen
- PELyon, PharmacoEpidemiology Lyon, 210 avenue Jean Jaurès, 69007, Lyon, France
| | - Faustine Dalon
- PELyon, PharmacoEpidemiology Lyon, 210 avenue Jean Jaurès, 69007, Lyon, France
| | - Maëva Nolin
- PELyon, PharmacoEpidemiology Lyon, 210 avenue Jean Jaurès, 69007, Lyon, France
| | - Eric Van Ganse
- PELyon, PharmacoEpidemiology Lyon, 210 avenue Jean Jaurès, 69007, Lyon, France.
- Hospices Civils de Lyon, Croix-Rousse University Hospital, Department of Respiratory Medicine, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.
- RESearch on HealthcAre PErformance (RESHAPE), Claude Bernard Lyon 1 University, 8 avenue Rockefeller, 69003, Lyon, France.
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Xiaohong X, Liqiang W, Na L, Xinqing L, Yinyin Q, Ming L, Ming O, Qian H, Qun L, Shiyue L, Chunyan L, Xiaoqian W, Shuanying Y, Wei H, Mei L, Ping W, Chengzhi Z. Management and Prognosis of Interstitial Lung Disease With Lung Cancer (ILD-LC): A Real-World Cohort From Three Medical Centers in China. Front Mol Biosci 2021; 8:660800. [PMID: 33869290 PMCID: PMC8044367 DOI: 10.3389/fmolb.2021.660800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/08/2021] [Indexed: 02/02/2023] Open
Abstract
Background and Objective Interstitial lung disease with lung cancer (ILD-LC) is rare and its management has not been fully described. This study aimed to investigate the management and prognosis of ILD-LC patients in China. Methods The present analysis is a retrospective real-world cohort study. Clinical data of ILD-LC patients were obtained from 3 hospitals in China. The overall survival (OS) of patients was analyzed. Univariate and multivariate regression analyses were performed. Results One hundred eighty-four ILD-LC patients included were biased toward male (85.3%), smokers (75.5%), idiopathic pulmonary fibrosis (IPF) (58.2%) patients with comorbidities (67.9%) and ECOG-PS score of 1 (65.2%). Most patients were advanced peripheral non-small cell lung cancer. The initial anti-cancer regimen for ILD-LC is mainly chemotherapy, and patients with early-stage LC prefer surgery. In the anti-cancer cohort, the number of ILD-LC patients who underwent the 2nd and 3rd or more anti-cancer regimens were 78 (55.7%) and 32 (22.8%), respectively. In the non-anticancer cohort, the median OS was 3.5 months. In the early-stage cohort, the median OS was 14.2 months in the systematic therapy group; however, the median OS was not reached in the surgery group. In the advanced-stage cohort with systematic therapy, the median OS was 7.2 months. Interstitial pneumonia (IIP) and anti-angiogenesis were associated with OS in the univariate analysis, whereas anti-angiogenesis was an independent protective factor for advanced LC with ILD. Conclusion Patients with ILD-LC have very poor prognosis. Appropriate anti-tumor treatment can prolong the survival time of patients who can tolerate it. Targeted therapy and immunotherapy are alternative treatments for LC patients with mild ILD. For ILD patients with advanced LC, antiangiogenic regimens significantly improve the prognosis of the disease.
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Affiliation(s)
- Xie Xiaohong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Wang Liqiang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Li Na
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lin Xinqing
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Qin Yinyin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Liu Ming
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Ouyang Ming
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Han Qian
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Luo Qun
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Li Shiyue
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
| | - Li Chunyan
- Department of Respiratory and Critical Care Medicine, The First Medical Center of PLA General Hospital, Beijing, China
| | - Wang Xiaoqian
- Department of Respiratory and Critical Care Medicine, The First Medical Center of PLA General Hospital, Beijing, China
| | - Yang Shuanying
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huang Wei
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Liu Mei
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wang Ping
- Department of Respiratory and Critical Care Medicine, The Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Zhou Chengzhi
- State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China
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Cottin V, Bergot E, Bourdin A, Nunes H, Prévot G, Wallaert B, Marchand-Adam S. Expectations about treatment of idiopathic pulmonary fibrosis: Comparative survey of patients, carers and physicians (the RESPIR French survey). Respir Med Res 2021; 79:100811. [PMID: 33618076 DOI: 10.1016/j.resmer.2020.100811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/22/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
CONTEXT Idiopathic pulmonary fibrosis (IPF) is a severe chronic disease during which anxiety and depression are frequent comorbidities. Better knowledge of patients' expectations is needed to inform an action plan to improve medical care. AIM To describe feelings and expectations of patients suffering from IPF and of their carers about antifibrotic therapy and compare them to what is perceived by their pulmonologist. METHODS National prospective study on practices and perceptions. Specific questionnaires were e-mailed to all 3276 pulmonologists in France who, in turn, invited patients and carers to participate in a survey. RESULTS 147 pulmonologists, 161 patients and 144 carers participated in the survey. The role of the carer was evaluated as "important" or "very important" by more than 90% of participants, i.e. pulmonologists, patients or carers. Inconsistencies between how patients felt and how pulmonologists perceived them were identified: 88% of patients responded that they understood quite well what IPF is (vs. 75% of patients according to pulmonologists); 85.5% of patients said they were determined to fight the disease (vs. 68.0%); 61.7% of patients wanted to be kept informed of potential complications before they occurred (vs. 69.6%) and 81.2% wanted to be involved in therapeutic decisions (vs. 43.1%). Globally, patients had a more positive view of antifibrotic therapies than expected by pulmonologists: 41.5% evaluated their advantages superior to what they had expected (vs. 29.1% of patients according to pulmonologists) and 76.5% had a positive image of the benefits/disadvantages ratio (vs. 62.4%). Although pulmonologists had the impression that they were keeping their patients well-informed about exacerbations, hospital stays and the possible negative evolution of the disease despite antifibrotic therapies, 34.0%, 42.0% and 22.0% of patients respectively declared not being aware of these aspects. CONCLUSION The feelings of patients suffering from IPF regarding their disease and treatment globally proved more positive compared with how pulmonologists perceived them. Taking into account the expectations and needs of patients may allow healthcare professionals to better address their needs and priorities.
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Affiliation(s)
- V Cottin
- National reference coordinating center for rare lung diseases, pulmonology department, Louis-Pradel hospital, hospices civils de Lyon, UMR754, université de Lyon, université Claude-Bernard Lyon 1, INREA, member of OrphaLung, RespiFil, Radico-ILD, and ERN-LUNG, Lyon, France.
| | - E Bergot
- Pulmonology department, University-affiliated hospital of Caen, Caen, France
| | - A Bourdin
- Pulmonology and addictology department, University-affiliated hospital of Montpellier, Montpellier, France
| | - H Nunes
- Pulmonology department, AP-HP, Avicenne University Hospital, Bobigny, France
| | - G Prévot
- Pulmonology department, Hospital of Toulouse, Toulouse, France
| | - B Wallaert
- Pulmonology and Allergy/immunology department, Regional University-affiliated hospital of Lille, Lille, France
| | - S Marchand-Adam
- Pulmonology department, Regional University-affiliated hospital of Tours, Tours, France
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22
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Andrejak C, Cottin V, Crestani B, Debieuvre D, Gonzalez-Bermejo J, Morelot-Panzini C, Stach B, Uzunhan Y, Maitre B, Raherison C. [Guide for management of patients with possible respiratory sequelae after a SARS-CoV-2 pneumonia. Support proposals developed by the French-speaking Respiratory Medicine Society. Version of 10 November 2020]. Rev Mal Respir 2020; 38:114-121. [PMID: 33280941 PMCID: PMC7691188 DOI: 10.1016/j.rmr.2020.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/24/2020] [Indexed: 11/09/2022]
Abstract
La Société de Pneumologie de Langue Française (SPLF) propose un guide pour la prise en charge thérapeutique des patients ayant d’éventuelles séquelles respiratoires après avoir présenté une pneumonie à SARS-CoV-2 (COVID-19). Les propositions s’appuient sur les données connues des précédentes épidémies, les données préliminaires publiées sur le suivi après COVID-19 et les avis d’experts. Les propositions ont été élaborées par un groupe d’experts puis soumises selon la méthode Delphi à un panel composé de 22 pneumologues. Dix-sept propositions ont été validées, qui vont des examens complémentaires à réaliser après le bilan minimal proposé dans le guide de suivi de la SPLF à la place de la corticothérapie inhalée ou systémique et des médicaments antifibrosants. Ces propositions pourront évoluer dans le temps au fil des connaissances sur le sujet. Ce guide insiste sur l’importance de la discussion multidisciplinaire.
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Affiliation(s)
- C Andrejak
- Service de pneumologie, CHU Amiens-Picardie, UR 4294 AGIR, université Picardie Jules-Verne, 80054 Amiens, France.
| | - V Cottin
- Service de pneumologie, centre de référence des maladies pulmonaires rares, Hospices Civils de Lyon, université de Lyon, INRAE, Lyon, France
| | - B Crestani
- Service de pneumologie, hôpital Bichat, université de Paris, inserm UMR1152, 75108 Paris, France
| | - D Debieuvre
- Service de pneumologie, groupe hospitalier de la région Mulhouse Sud-Alsace, hôpital Émile-Muller, Mulhouse, France
| | - J Gonzalez-Bermejo
- Service de pneumologie, médecine intensive et réanimation Pitié-Salpêtrière, Sorbonne Université, inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - C Morelot-Panzini
- Service de pneumologie, médecine intensive et réanimation Pitié-Salpêtrière, Sorbonne Université, inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Paris, France
| | - B Stach
- Cabinet médical Saint Michel, 59300 Valenciennes, France
| | - Y Uzunhan
- Service de pneumologie, hôpital Avicenne, Assistance Publique - hôpitaux de Paris, Inserm U1272, Laboratoire "Hypoxie et Poumon", université Paris Nord, Bobigny, France
| | - B Maitre
- Service de pneumologie, centre hospitalier intercommunal de créteil, université Paris Est Créteil, 94000 Créteil, France
| | - C Raherison
- Service des maladies respiratoires, CHU de Bordeaux, U1219 Epicene université de Bordeaux, France
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23
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Li X, Yu X, Xie Y, Feng Z, Ma Y, Chen Y, Li J. Critical appraisal of the quality of clinical practice guidelines for idiopathic pulmonary fibrosis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1405. [PMID: 33313150 PMCID: PMC7723592 DOI: 10.21037/atm-20-3200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Clinical practice guidelines (CPGs) have long served as an essential tool for clinicians to rationalize their treatment in practice. However, the quality of guidelines varies greatly. The present study aimed to analyze high-quality CPGs of idiopathic pulmonary fibrosis (IPF) and highlight the potential for further improvement. Methods Three guideline developers’ websites, PubMed, Embase, and Web of Science, as well as a public search engine, Google Scholar, were searched to retrieve CPGs regarding the management of IPF. The methodology and reporting quality of retrieved CPGs were assessed using the validated Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE II) and Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist. Results Twelve IPF CPGs were reviewed, among which 7 (58.3%) were considered as “recommended” and 1 (8.3%) as “recommended with modifications”. Among the 6 domains of AGREE II, scope and purpose (70.99%) and clarity of presentation (68.06%) were considered to be the fields in which CPGs performed best, evidenced by the highest mean AGREE II scores. The domains in which the reviewed CPGs received the lowest mean scores were rigor of development (50.87%) and applicability (34.14%). The intraclass correlation coefficient scores were excellent in each domain. The basic information domain received the highest overall reporting rate in the 7 domains of the RIGHT checklist; the other 6 domains had a full reporting rate of <50%. Eight items had a satisfactory level of reporting, whereas 14 items had poor reporting according to the RIGHT checklist. Correlation analysis revealed a highly positive correlation between the methodology and reporting quality of CPGs for IPF (r=0.872). Conclusions The methodological quality of selected IPF CPGs fluctuated greatly, and the full reporting rate was found to be quite low in some domains. In the future, we should focus not only on improving the methodological quality in the development of guidelines, but also on the reporting quality of guidelines.
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Affiliation(s)
- Xuanlin Li
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Zhengzhou, China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Xueqing Yu
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Zhengzhou, China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China.,Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Yang Xie
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Zhengzhou, China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China.,Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Zhenzhen Feng
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Zhengzhou, China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yanfang Ma
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Chinese GRADE Center, Lanzhou, China.,WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Chinese GRADE Center, Lanzhou, China.,WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Jiansheng Li
- Co-construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Zhengzhou, China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
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Jones SA, McGovern M, Lidove O, Giugliani R, Mistry PK, Dionisi-Vici C, Munoz-Rojas MV, Nalysnyk L, Schecter AD, Wasserstein M. Clinical relevance of endpoints in clinical trials for acid sphingomyelinase deficiency enzyme replacement therapy. Mol Genet Metab 2020; 131:116-123. [PMID: 32616389 DOI: 10.1016/j.ymgme.2020.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Acid sphingomyelinase deficiency (ASMD) also known as Niemann-Pick disease, is a rare lysosomal storage disorder with a diverse disease spectrum that includes slowly progressive, chronic visceral (type B) and neurovisceral forms (intermediate type A/B), in addition to infantile, rapidly progressive fatal neurovisceral disease (type A). PURPOSE AND METHODS We review the published evidence on the relevance of splenomegaly and reduced lung diffusion capacity to the clinical burden of chronic forms of ASMD. Targeted literature searches were conducted to identify relevant ASMD and non-ASMD studies for associations between diffusing capacity of the lungs for carbon monoxide (DLCO) and splenomegaly, with clinical parameters and outcome measures. RESULTS Respiratory disease and organomegaly are primary and independent contributors to mortality, disease burden, and morbidity for patients with chronic ASMD. The degree of splenomegaly correlates with short stature, atherogenic lipid profile, and degree of abnormality of hematologic parameters, and thus may be considered a surrogate marker for bleeding risk, abnormal lipid profiles and possibly, liver fibrosis. Progressive lung disease is a prevalent clinical feature of chronic ASMD, contributing to a decreased quality of life (QoL) and an increased disease burden. In addition, respiratory-related complications are a major cause of mortality in ASMD. CONCLUSIONS The reviewed evidence from ASMD natural history and observational studies supports the use of lung function and spleen volume as clinically meaningful endpoints in ASMD trials that translate into important measures of disease burden for patients.
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Affiliation(s)
- Simon A Jones
- Manchester University NHS Trust Ctr Genomic Medicine, Manchester, UK.
| | | | - Olivier Lidove
- Groupe Hospitalier Diaconesses-Croix St Simon, Paris, France
| | - Roberto Giugliani
- Med Genet Serv & DR BRASIL Research Group, HCPA, Dept Genetics, UFRGS, and INAGEMP, Porto Alegre, Brazil
| | | | | | | | | | | | - Melissa Wasserstein
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
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25
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Cottin V, Guéguen S, Jouneau S, Nunes H, Crestani B, Bonniaud P, Wemeau L, Israël-Biet D, Chevereau M, Dufaure-Garé I, Amselem S, Clément A. Fibrose pulmonaire idiopathique au sein de la cohorte RaDiCo-PID. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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26
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Patrucco F, Venezia L, Nicali R, Pellicano R, Bellan M, Balbo PE. Idiopathic pulmonary fibrosis and gastroesophageal reflux. ACTA ACUST UNITED AC 2020. [DOI: 10.23736/s0026-4954.20.01865-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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27
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Valenzuela C, Torrisi SE, Kahn N, Quaresma M, Stowasser S, Kreuter M. Ongoing challenges in pulmonary fibrosis and insights from the nintedanib clinical programme. Respir Res 2020; 21:7. [PMID: 31906942 PMCID: PMC6945404 DOI: 10.1186/s12931-019-1269-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/23/2019] [Indexed: 01/06/2023] Open
Abstract
The approvals of nintedanib and pirfenidone changed the treatment paradigm in idiopathic pulmonary fibrosis (IPF), and increased our understanding of the underlying disease mechanisms. Nonetheless, many challenges and unmet needs remain in the management of patients with IPF and other progressive fibrosing interstitial lung diseases.This review describes how the nintedanib clinical programme has helped to address some of these challenges. Data from this programme have informed changes to the IPF diagnostic guidelines, the timing of treatment initiation, and the assessment of disease progression. The use of nintedanib to treat patients with advanced lung function impairment, concomitant emphysema, patients awaiting lung transplantation and patients with IPF and lung cancer is discussed. The long-term use of nintedanib and an up-to-date summary of nintedanib in clinical practice are discussed. Directions for future research, namely emerging therapeutic options, precision medicine and other progressive fibrosing interstitial lung diseases, are described.Further developments in these areas should continue to improve patient outcomes.
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Affiliation(s)
- Claudia Valenzuela
- Hospital Universitario de La Princesa, Instituto de Investigación Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Sebastiano Emanuele Torrisi
- University Hospital Policlinico-Vittorio Emanuele, Catania, Italy
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Nicolas Kahn
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, Member of the German Center for Lung Research, Heidelberg, Germany
| | - Manuel Quaresma
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Susanne Stowasser
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
- Translational Lung Research Center, Member of the German Center for Lung Research, Heidelberg, Germany.
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28
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Manolescu D, Oancea C, Timar B, Traila D, Malita D, Birsasteanu F, Tudorache V. Ultrasound mapping of lung changes in idiopathic pulmonary fibrosis. CLINICAL RESPIRATORY JOURNAL 2019; 14:54-63. [PMID: 31675455 DOI: 10.1111/crj.13101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 07/26/2019] [Accepted: 10/27/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) is the most common and severe form of idiopathic interstitial pneumonia, accounted for 20% of cases of interstitial lung disease (ILD). In this study, we sought to compare the lung changes of IPF using a lung ultrasound (LUS) protocol of 12 zones with "current standard" high resolution computed tomography (HRCT) diagnostic method and overlap it with the functional pulmonary test as a complete clinical and imaging evaluation. METHODS Thirty-one patients were included in the study and performed HRCT and pulmonary functional tests (PFT). A 12-lung zones' LUS protocol was used and compared with HRCT and PFT. RESULTS The HRCT total fibrotic score had a correlation coefficient of 0.454 (P < 0.005) with predicted FVC and 0.713 with predicted DLCO (P < 0.001). Both the median of the number of B-lines and the average of the thickness of the pleural line obtained in the LUS assessment had a positively and statistically significant correlation with the HRCT fibrotic score P < 0.001. The pleural thickness of 2.4 mm is the cut-off value of the mild form of fibrosis with a sensitivity of 0.958 and a specificity of 0.994. CONCLUSION B-lines and the average thickness of the pleural line as LUS markers of the fibrotic interstitial syndrome are highly and positively correlated with HRCT score, FVC and DLCO. LUS as a complementary method in the clinical management of IPF could be used more often by skilled clinicians to assess patients in terms of possible diagnosis and monitoring of IPF.
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Affiliation(s)
- Diana Manolescu
- Department of Radiology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Cristian Oancea
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Bogdan Timar
- Department of Biostatistics and Medical Informatics, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Daniel Traila
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Daniel Malita
- Department of Radiology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Florica Birsasteanu
- Department of Radiology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Voicu Tudorache
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
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29
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Fernandes L, Nasser M, Ahmad K, Cottin V. Interstitial Pneumonia With Autoimmune Features (IPAF). Front Med (Lausanne) 2019; 6:209. [PMID: 31681774 PMCID: PMC6798044 DOI: 10.3389/fmed.2019.00209] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/09/2019] [Indexed: 11/13/2022] Open
Abstract
A significant proportion of patients with interstitial lung disease (ILD) manifest autoimmune features, but do not fulfill the diagnostic criteria for a definite connective tissue disease (CTD). In 2015, the European Respiratory Society (ERS) and American Thoracic Society (ATS) “Task Force on undifferentiated Forms of connective tissue disease-associated interstitial lung disease” proposed classification criteria for a so-called research category of Interstitial Pneumonia with Autoimmune Features (IPAF). These classification criteria were based on a combination of features from three domains: a clinical domain consisting of extra-thoracic features; a serologic domain with specific autoantibodies; and a morphologic domain with imaging patterns, histopathological findings or multi-compartment involvement. Patients meeting IPAF criteria tend to have a history of smoking similar to patients with idiopathic pulmonary fibrosis. The most frequent clinical and serological markers of autoimmune features are Raynaud' phenomenon and positive antinuclear antibodies, respectively. Non-specific interstitial pneumonia is the predominant radiologic and histopathologic pattern, although patients meeting IPAF criteria through the clinical and serologic domains may also have a usual interstitial pneumonia pattern. Management should be carefully individualized on a case-by-case basis in keeping with the wide heterogeneity of IPAF and lack of evidence in this particular subgroup of patients. Prognosis is generally intermediate between that of idiopathic pulmonary fibrosis and connective tissue disease-associated interstitial lung disease, but substantially variable according to the predominant histologic and radiologic patterns. As acknowledged by the Task Force, the proposed classification scheme of IPAF is a research concept that will need revision and refinement based on data to better inform prognostication and patient care.
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Affiliation(s)
- Ligia Fernandes
- Departamento do Tórax, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Mouhamad Nasser
- Department of Respiratory Medicine, National Reference Center for Rare Pulmonary Diseases, Hospices Civils de Lyon, Lyon, France
| | - Kais Ahmad
- Department of Respiratory Medicine, National Reference Center for Rare Pulmonary Diseases, Hospices Civils de Lyon, Lyon, France
| | - Vincent Cottin
- Department of Respiratory Medicine, National Reference Center for Rare Pulmonary Diseases, Hospices Civils de Lyon, Lyon, France.,Claude Bernard Lyon 1 University, University of Lyon, INRA, UMR754, Lyon, France
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30
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Jouneau S, Gamez AS, Traclet J, Nunes H, Marchand-Adam S, Kessler R, Israël-Biet D, Borie R, Strombom I, Scalori A, Crestani B, Valeyre D, Cottin V. A 2-Year Observational Study in Patients Suffering from Idiopathic Pulmonary Fibrosis and Treated with Pirfenidone: A French Ancillary Study of PASSPORT. Respiration 2019; 98:19-28. [DOI: 10.1159/000496735] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/08/2019] [Indexed: 11/19/2022] Open
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Richeldi L, Launders N, Martinez F, Walsh SLF, Myers J, Wang B, Jones M, Chisholm A, Flaherty KR. The characterisation of interstitial lung disease multidisciplinary team meetings: a global study. ERJ Open Res 2019; 5:00209-2018. [PMID: 30949489 PMCID: PMC6441673 DOI: 10.1183/23120541.00209-2018] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/05/2019] [Indexed: 01/04/2023] Open
Abstract
Multidisciplinary team (MDT) diagnosis of interstitial lung disease (ILD) has been proposed as a gold standard, but there are no formal recommendations for MDT process or composition and limited knowledge regarding prevalence in routine practice. We performed a systematic evaluation of ILD diagnostic practice across a range of healthcare settings around the world. Electronic questionnaires were distributed across all global regions via society and collaborators networks. Responses from 457 unique centres across 64 countries were included in the analysis. Of the 350 (76.6%) centres holding formal meetings, the majority held face-to-face MDT meetings (80%), for a minimum of 30 min (93%), and discussed diagnosis (96.9%) and patient management (94.9%) at the meetings. Compared with non-academic and academic non-ILD centres, ILD academic centres reported a higher ILD caseload, held more formal MDT meetings, and were more likely to include histopathology and rheumatology specialists in their diagnostic team. Of the centres holding MDT meetings, 5.5% routinely discussed all new cases at such meetings. An MDT approach to ILD diagnosis is consistently interpreted and widely implemented across a range of routine care settings around the world. This observation will inform future ILD diagnostic agreement studies and diagnostic pathway recommendations. In real-world practice, ILD diagnosis uses a multidisciplinary team approach, irrespective of country or healthcare settinghttp://ow.ly/I1Di30nMNTX
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Affiliation(s)
- Luca Richeldi
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Fernando Martinez
- Joan and Sanford I. Weill Dept of Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | | | - Jeffrey Myers
- Dept of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Bonnie Wang
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mark Jones
- NIHR Southampton Biomedical Research Centre, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Kevin R Flaherty
- Division of Pulmonary and Critical Care Medicine, Dept of Medicine, University of Michigan, Ann Arbor, MI, USA
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Wang Z, Bonella F, Li W, Boerner EB, Guo Q, Kong X, Zhang X, Costabel U, Kreuter M. Gastroesophageal Reflux Disease in Idiopathic Pulmonary Fibrosis: Uncertainties and Controversies. Respiration 2018; 96:571-587. [PMID: 30308515 DOI: 10.1159/000492336] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/23/2018] [Indexed: 11/19/2022] Open
Abstract
The mechanisms of idiopathic pulmonary fibrosis (IPF), a rare, devastating disease with a median survival of 3-5 years, are not fully understood. Gastroesophageal reflux disease (GERD) is a frequent comorbidity encountered in IPF. Hypothetically, GERD-associated microaspiration may lead to persistent inflammation impairing lung infrastructure, thereby possibly accelerating the progression of IPF. IPF may increase intrathoracic pressure, which can aggravate GERD and vice versa. On the basis of the possible beneficial effects of antireflux or antacid therapy on lung function, acute exacerbation, and survival, the recent international IPF guideline recommends antacid therapies for patients with IPF, regardless of symptomatic GERD. However, due to newer conflicting data, several national guidelines do not support this recommendation. Elucidation of these questions by further clinical and bench-to-bedside research may provide us with rational clinical diagnostic and therapeutic approaches concerning GERD in IPF. The present review aims to discuss the latest data on the controversial association of IPF and GERD.
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Affiliation(s)
- Zheng Wang
- Department of Respiratory and Critical Medicine, Zhengzhou University People's Hospital, The Provincial People's Hospital Affiliated to Henan University, Zhengzhou,
| | - Francesco Bonella
- Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University Hospital, Duisburg-Essen University, Essen, Germany
| | - Wenting Li
- Third Liver Unit, Department of Infectious Diseases and Hepatology, Anhui Provincial Hospital, the First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Eda B Boerner
- Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University Hospital, Duisburg-Essen University, Essen, Germany
| | - Qiongya Guo
- Department of Digestive Diseases, Zhengzhou University People's Hospital, The Provincial People's Hospital Affiliated to Henan University, Zhengzhou, China
| | - Xianglong Kong
- Department of Respiratory Medicine, The First Hospital of Changsha, Changsha, China
| | - Xiaoju Zhang
- Department of Respiratory and Critical Medicine, Zhengzhou University People's Hospital, The Provincial People's Hospital Affiliated to Henan University, Zhengzhou, China
| | - Ulrich Costabel
- Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University Hospital, Duisburg-Essen University, Essen, Germany
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg, member of the German Center for Lung Research, Heidelberg, Germany
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Porte F, Cottin V, Catella L, Luciani L, Le Lay K, Bénard S. Health economic evaluation in idiopathic pulmonary fibrosis in France. Curr Med Res Opin 2018; 34:1731-1740. [PMID: 29368948 DOI: 10.1080/03007995.2018.1433143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a specific form of chronic, progressive, fibrosing interstitial pneumonia of unknown cause. To date, there is no specific cure for IPF, and only two treatments (pirfenidone and nintedanib) have marketing authorizations and recommendations in international and French guidelines. OBJECTIVES A cost-utility analysis (CUA) has been conducted to evaluate the efficiency of nintedanib, in comparison to all available alternatives, in a French setting using the official methodological guidelines. METHODS A previously developed lifetime Markov model was adapted to the French setting by simulating the progression of IPF patients in terms of lung function decline, incidence of acute exacerbations, and death. Considering the effect of IPF on patients' quality-of-life, a CUA integrating quality adjusted life years (QALY) was chosen as the primary outcome measure in the main analysis. One-way, probabilistic, and scenario sensitivity analyses were performed to evaluate the robustness of the model. RESULTS Treatment with nintedanib resulted in an estimated total cost of €76,414 (vs €82,665 for pirfenidone). In comparison with all other available options, nintedanib was predicted to provide the most QALY gained (3.34 vs 3.29). This analysis suggests that nintedanib has a 59.0% chance of being more effective than pirfenidone and s 77.3% chance of being cheaper than pirfenidone. Sensitivity analyses showed the results of the CUA to be robust. CONCLUSIONS In conclusion, this CUA has found that nintedanib appears to be a more cost-effective therapeutic option than pirfenidone in a French setting, due to fewer acute exacerbations and a better tolerability profile.
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Affiliation(s)
| | - Vincent Cottin
- b Hospices Civils de Lyon, Hôpital Louis Pradel, Service de pneumologie Centre de référence national des maladies pulmonaires rares, Université Claude Bernard Lyon 1, Université de Lyon , Lyon , France
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Peiffer G, Underner M, Perriot J. [The respiratory effects of smoking]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:133-144. [PMID: 29793770 DOI: 10.1016/j.pneumo.2018.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 02/05/2023]
Abstract
A marked increase in the morbidity and mortality of a large number of broncho-pulmonary diseases has been documented in relation to smoking. The influence of tobacco smoking on various respiratory conditions. is discussed: incidence, severity or natural history modification of some respiratory illnesses: obstructive lung diseases (COPD, asthma), lung cancer, bacterial, viral respiratory infections, with the impact of smoking on tuberculosis. Finally, the relationship of tobacco with diffuse interstitial lung disease: protective role of smoking (controversial in sarcoidosis, real in hypersensitivity pneumonitis). The benefits of smoking cessation are described.
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Affiliation(s)
- G Peiffer
- Service de pneumologie, CHR Metz-Thionville, hôpital de Mercy, 1, allée du Château 57085 Metz cedex 3, France.
| | - M Underner
- Unité de recherche clinique, centre hospitalier Henri-Laborit, 86000 Poitiers, France.
| | - J Perriot
- CLAT 63, dispensaire Emile-Roux, 11, rue Vaucanson, 63100 Clermont-Ferrand, France.
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Cottin V, Crestani B, Cadranel J, Marchand-Adam S, Prévot G, Wallaert B, Valeyre D. Incertitude diagnostique, diagnostic de travail et évolution des recommandations sur la fibrose pulmonaire. Rev Mal Respir 2018; 35:479-480. [DOI: 10.1016/j.rmr.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/28/2018] [Indexed: 11/29/2022]
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Lyseng-Williamson KA. Reply-Letter to the Editor: Pirfenidone tablets in idiopathic pulmonary fibrosis: a profile of their use. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0488-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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38
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Le diagnostic de FPI : un long fleuve tranquille ? Rev Mal Respir 2018; 35:477-478. [DOI: 10.1016/j.rmr.2018.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/28/2018] [Indexed: 11/24/2022]
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Vincent F, Nunes H, Gaudry S. Progress in the management of IPF-related acute exacerbations: a goal for patients, respirologists and intensivists. Eur Respir J 2018; 51:51/2/1702419. [DOI: 10.1183/13993003.02419-2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 11/29/2017] [Indexed: 11/05/2022]
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Abstract
Pirfenidone (Esbriet®) is available as capsules containing 267 mg of pirfenidone and, more recently, as bioequivalent tablets containing 267, 534 or 801 mg of pirfenidone. Both formulations are indicated to treat idiopathic pulmonary fibrosis (IPF), with pirfenidone being shown to generally reduce the rate of decline in forced vital capacity in patients with mild to moderate IPF, while prolonging progression-free survival and reducing the risk of IPF-related and all-cause mortality. The availability of the tablet formulation reduces the daily pill burden of pirfenidone, as the recommended daily divided maintenance dose of 2403 mg/day may be administered as one 801 mg tablet three times daily instead of three 267 mg capsules three times daily. Pirfenidone is associated with gastrointestinal and skin-related events, with such events generally being manageable.
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Cottin V. [French recommendations for idiopathic pulmonary fibrosis: An updated working document for clinicians]. Rev Mal Respir 2017; 34:789-790. [PMID: 29102032 DOI: 10.1016/j.rmr.2017.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- V Cottin
- Centre national de référence des maladies pulmonaires rares, pneumologie, hôpital Louis-Pradel, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France.
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