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Leuschner G, Klotsche J, Kreuter M, Prasse A, Wirtz H, Pittrow D, Frankenberger M, Behr J, Kneidinger N. Idiopathic Pulmonary Fibrosis in Elderly Patients: Analysis of the INSIGHTS-IPF Observational Study. Front Med (Lausanne) 2020; 7:601279. [PMID: 33313046 PMCID: PMC7703706 DOI: 10.3389/fmed.2020.601279] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/09/2020] [Indexed: 12/15/2022] Open
Abstract
Background: An association between idiopathic pulmonary fibrosis (IPF) and advancing age is suspected since IPF occurs primarily in patients over 60 years of age. Though, little is known about the disease in the elderly. The aim of this study was to characterize elderly IPF patients using data from the longitudinal, German-wide INSIGHTS-IPF registry. Methods: Patients were grouped into elderly (≥75 years) and nonelderly IPF (<75 years) at the time of enrollment into the study. Baseline clinical characteristics, comorbidities, health related quality of life (HRQoL), medical therapy and survival were compared between age groups. Effects of antifibrotic therapy on forced vital capacity (FVC) were analyzed over 24 months. Results: Of 1,009 patients, 350 (34.7%) were ≥75 years old. Elderly IPF patients compared to younger patients had a higher number of comorbidities (3.6 ± 2.5 vs. 2.8 ± 2.3; p < 0.001). The mean ± SD EQ-5D score (0.64 ± 0.21 vs. 0.69 ± 0.21; p = 0.005), and the overall WHO-5 score (13.1 ± 5.9 vs. 14.3 ± 6.0; p = 0.015) were significantly lower while the UCSD-SOBQ (52.6 ± 31.2 vs. 45.5 ± 31.2; p = 0.030) was significantly higher in elderly patients, indicating a more impaired HRQoL and more breathlessness. At baseline, 55.4% of elderly and 56.8% of nonelderly patients with IPF were treated with antifibrotic therapy (p = 0.687). For FVC decline after initiation of antifibrotic therapy, there was neither a significant difference between age groups at the different time points over 24 months (beta: 0.41; 95%-CI: -0.98 to 1.81; p = 0.563) nor over the whole course of time (beta: -0.05; 95%-CI: -0.20 to 0.09; p = 0.478). All-cause mortality was higher in elderly patients (49.1 vs. 37.9%; HR 1.65; 95%-CI 1.36-2.00; p < 0.001). Antifibrotic therapy was associated with improved survival in IPF patients, independent from age (<75 years: beta 0.76; 95%-CI: 0.59-0.99; p = 0.049; ≥75 years: beta 0.71; 95%-CI: 0.51-0.98; p = 0.043). Conclusion: In real life, a significant proportion of IPF patients are ≥75 years old, characterized by higher number of comorbidities and global reduced HRQoL. However, the effect of an antifibrotic therapy was similar between age groups and associated with a survival benefit emphasizing the importance for an early antifibrotic therapy in IPF, independent from age.
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Affiliation(s)
- Gabriela Leuschner
- Comprehensive Pneumology Center (CPC-M), Asklepios Klinik Gauting and Helmholtz Center Munich, Ludwig-Maximilians University, München, Germany.,Department of Internal Medicine V, Ludwig-Maximilian University Munich, Munich, Germany.,German Center for Lung Research, München, Germany
| | - Jens Klotsche
- Epidemiology, German Rheumatism Research Center, A Leibniz Institute, Berlin, Germany
| | - Michael Kreuter
- German Center for Lung Research, München, Germany.,Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Antje Prasse
- German Center for Lung Research, München, Germany.,Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Germany.,Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Hubert Wirtz
- Abteilung für Pneumologie, Department Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Leipzig, Germany
| | - David Pittrow
- Institut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - Marion Frankenberger
- Comprehensive Pneumology Center (CPC-M), Asklepios Klinik Gauting and Helmholtz Center Munich, Ludwig-Maximilians University, München, Germany.,German Center for Lung Research, München, Germany
| | - Jürgen Behr
- Comprehensive Pneumology Center (CPC-M), Asklepios Klinik Gauting and Helmholtz Center Munich, Ludwig-Maximilians University, München, Germany.,Department of Internal Medicine V, Ludwig-Maximilian University Munich, Munich, Germany.,German Center for Lung Research, München, Germany
| | - Nikolaus Kneidinger
- Comprehensive Pneumology Center (CPC-M), Asklepios Klinik Gauting and Helmholtz Center Munich, Ludwig-Maximilians University, München, Germany.,Department of Internal Medicine V, Ludwig-Maximilian University Munich, Munich, Germany.,German Center for Lung Research, München, Germany
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2
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Jafri S, Ahmed N, Saifullah N, Musheer M. Epidemiology and Clinico-radiological features of Interstitial Lung Diseases. Pak J Med Sci 2020; 36:365-370. [PMID: 32292435 PMCID: PMC7150376 DOI: 10.12669/pjms.36.3.1046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: The literature on interstitial lung diseases is limited. The aim of this research was to make this entity of diseases more understandable to clinicians and general population of the region of Pakistan. Methods: We conducted a cross-sectional study on 253 Pakistani subjects who are a part of the hospital-based registry of JPMC. We performed statistical analyses on SPSS version 22.0. We included patients above 15 years of age who exhibited clinical clues and radiological signs of ILD during March 2016 through February 2018 and excluded those who were on tuberculosis treatment, suspected to be suffering from post-infection bronchiectasis, expectant females or had failed to follow-up. Results: There was a 2:3 male to female ratio. Mean age was 49.0±13.2 years. Majority were non-smokers. Idiopathic Pulmonary Fibrosis (IPF) was the commonest ILD (38.8%) followed by Non-Specific Interstitial Pneumonitis (NSIP) (15.1%). Most patients presented with dyspnea and dry cough and about half were clubbed (47.3%). Substantial IPF cases (52.6%) were suffering from GERD symptoms. Conclusion: IPF and NSIP were the major ILDs, GERD was the only predictor of IPF. This entity of lung diseases needs to be explored further to identify patterns of presentation and to make diagnosis at a manageable stage.
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Affiliation(s)
- Saira Jafri
- Saira Jafri, MBBS. FCPS (Pulmonology) trainee, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Naseem Ahmed
- Naseem Ahmed, MBBS, FCPS. Assistant Professor, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Nausheen Saifullah
- Nausheen Saifullah, MBBS, FCPS. Associate Professor, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - Mehak Musheer
- Mehak Musheer, MBBS. House Officer, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
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3
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Tran T, Šterclová M, Mogulkoc N, Lewandowska K, Müller V, Hájková M, Kramer MR, Jovanović D, Tekavec-Trkanjec J, Studnicka M, Stoeva N, Hejduk K, Dušek L, Suissa S, Vašáková M. The European MultiPartner IPF registry (EMPIRE): validating long-term prognostic factors in idiopathic pulmonary fibrosis. Respir Res 2020; 21:11. [PMID: 31915023 PMCID: PMC6951015 DOI: 10.1186/s12931-019-1271-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/29/2019] [Indexed: 01/03/2023] Open
Abstract
Background Several registries of idiopathic pulmonary fibrosis (IPF) have been established to better understand its natural history, though their size and duration of follow-up are limited. Here, we describe the large European MultiPartner IPF Registry (EMPIRE) and validate predictors of long-term survival in IPF. Methods The multinational prospective EMPIRE registry enrolled IPF patients from 48 sites in 10 Central and Eastern European countries since 2014. Survival from IPF diagnosis until death was estimated, accounting for left-truncation. The Cox proportional hazards regression model was used to estimate adjusted hazard ratios (HR) of death for prognostic factors, using restricted cubic splines to fit continuous factors. Results The cohort included 1620 patients (mean age at diagnosis 67.6 years, 71% male, 63% smoking history), including 75% enrolled within 6 months of diagnosis. Median survival was 4.5 years, with 45% surviving 5 years post-diagnosis. Compared with GAP stage I, mortality was higher with GAP stages II (HR 2.9; 95% CI: 2.3–3.7) and III (HR 4.0; 95% CI: 2.8–5.7) while, with redefined cut-offs, the corresponding HRs were 2.7 (95% CI: 1.8–4.0) and 5.8 (95% CI: 4.0–8.3) respectively. Mortality was higher with concurrent pulmonary hypertension (HR 2.0; 95% CI: 1.5–2.9) and lung cancer (HR 2.6; 95% CI: 1.3–4.9). Conclusions EMPIRE, one of the largest long-term registries of patients with IPF, provides a more accurate confirmation of prognostic factors and co-morbidities on longer term five-year mortality. It also suggests that some fine-tuning of the indices for mortality may provide a more accurate long-term prognostic profile for these patients.
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Affiliation(s)
- Tanja Tran
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Martina Šterclová
- Department of Respiratory Medicine of the First Faculty of Medicine Charles University, Thomayer Hospital, Vídeňská 800, 140 59, Prague 4, Czech Republic
| | - Nesrin Mogulkoc
- Department of Chest Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Katarzyna Lewandowska
- 1st Department of Pulmonary Diseases, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Veronika Müller
- Department of Pulmonology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Marta Hájková
- Clinic of Pneumology and Phthisiology, University Hospital Bratislava, Bratislava, Slovakia
| | - Mordechai R Kramer
- Institute of Pulmonary Medicine, Rabin Medical Center, Petah Tikva, Israel
| | - Dragana Jovanović
- University Hospital of Pulmonology, Clinical Center of Serbia, Belgrade, Serbia
| | | | | | - Natalia Stoeva
- Department of Pulmonology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Karel Hejduk
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ladislav Dušek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Samy Suissa
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Martina Vašáková
- Department of Respiratory Medicine of the First Faculty of Medicine Charles University, Thomayer Hospital, Vídeňská 800, 140 59, Prague 4, Czech Republic.
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Ogata-Suetsugu S, Hamada N, Tsuda T, Takata S, Kitasato Y, Inoue N, Nagata N, Yatera K, Mukae H, Yoshii C, Hoshino T, Fujita M, Watanabe K, Tokunaga S, Nakanishi Y. Characteristics of tobacco-related lung diseases in Fukuoka Prefecture, Japan: A prospective, multi-institutional, observational study. Respir Investig 2019; 58:74-80. [PMID: 31727581 DOI: 10.1016/j.resinv.2019.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 09/09/2019] [Accepted: 10/02/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tobacco smoking causes a variety of smoking-related diseases, death, and economic damage. Despite targeted anti-smoking campaigns, tobacco-related deaths are expected to increase in Japan. We investigated the current state of non-cancerous lung diseases such as idiopathic interstitial pneumonias (IIPs), chronic obstructive pulmonary disease (COPD), and combined pulmonary fibrosis and emphysema (CPFE), which are known to be highly related to tobacco smoking. METHODS This prospective multi-institutional observational study involved 29 major hospitals within the Fukuoka Prefecture area (Fukuoka tobacco-related lung disease registry study group). Patients diagnosed with IIPs, including CPFE and COPD, registered from September 1, 2013 to April 30, 2016 were included. Clinical background information, laboratory and pulmonary function test results, findings of imaging tests, including chest radiography and chest computed tomography, and DNA isolated from peripheral blood were collected from each patient. Follow-up surveillance involved collection of data regarding the exacerbation of disease and death until 5 years of registration. In the present study, we report the baseline characteristics of the patients registered in this surveillance study. RESULTS Overall, 1016 patients (524 with IIPs, including 145 CPFE and 492 with COPD) were enrolled. Among the patients with COPD, 96.8% were current or former smokers. Among the patients with IIPs, 69.9% were current or former smokers. CONCLUSION This study revealed the current status of lung diseases potentially related to tobacco smoking in Fukuoka Prefecture. Both COPD and CPFE were highly related to tobacco smoking, whereas 30% of patients with IIPs had never smoked.
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Affiliation(s)
- Saiko Ogata-Suetsugu
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Naoki Hamada
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Toru Tsuda
- Kirigaoka Tsuda Hospital, Fukuoka, Japan.
| | - Shohei Takata
- Department of Respiratory Diseases, National Hospital Organization, Fukuoka Higashi Medical Center, Fukuoka, Japan.
| | - Yasuhiko Kitasato
- Department of Respiratory Medicine, Kurume General Hospital, Fukuoka, Japan.
| | - Naoyuki Inoue
- Division of Respiratory Medicine, Kyushu Rosai Hospital, Fukuoka, Japan.
| | - Nobuhiko Nagata
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan.
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Chiharu Yoshii
- Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Fukuoka, Japan.
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan.
| | - Masaki Fujita
- Department of Respiratory Medicine, Fukuoka University School of Medicine, Fukuoka, Japan.
| | - Kentaro Watanabe
- General Medical Center, Fukuoka University School of Medicine, Fukuoka, Japan.
| | - Shoji Tokunaga
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan.
| | - Yoichi Nakanishi
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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5
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Kreuter M, Swigris J, Pittrow D, Geier S, Klotsche J, Prasse A, Wirtz H, Koschel D, Andreas S, Claussen M, Grohé C, Wilkens H, Hagmeyer L, Skowasch D, Meyer JF, Kirschner J, Gläser S, Kahn N, Welte T, Neurohr C, Schwaiblmair M, Held M, Bahmer T, Oqueka T, Frankenberger M, Behr J. The clinical course of idiopathic pulmonary fibrosis and its association to quality of life over time: longitudinal data from the INSIGHTS-IPF registry. Respir Res 2019; 20:59. [PMID: 30876420 PMCID: PMC6420774 DOI: 10.1186/s12931-019-1020-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/27/2019] [Indexed: 02/06/2023] Open
Abstract
Background Quality of life (QoL) is profoundly impaired in patients with idiopathic pulmonary fibrosis (IPF). However, data is limited regarding the course of QoL. We therefore analysed longitudinal data from the German INSIGHTS-IPF registry. Methods Clinical status and QoL were assessed at enrollment and subsequently at 6- to 12-months intervals. A range of different QoL questionnaires including the St. George’s Respiratory Questionnaire (SGRQ) were used. Results Data from 424 patients were included; 76.9% male; mean age 68.7 ± 9.1 years, mean FVC% predicted 75.9 ± 19.4, mean DLCO% predicted 36.1 ± 15.9. QoL worsened significantly during follow-up with higher total SGRQ scores (increased by 1.47 per year; 95% CI: 1.17 to 1.76; p < 0.001) and higher UCSD-SOBQ scores and lower EQ-5D VAS and WHO-5 scores. An absolute decline in FVC% predicted of > 10% was associated with a significant deterioration in SGRQ (increasing by 9.08 units; 95% CI: 2.48 to 15.67; p = 0.007), while patients with stable or improved FVC had no significantly change in SGRQ. Patients with a > 10% decrease of DLCO % predicted also had a significant increase in SGRQ (+ 7.79 units; 95% CI: 0.85 to 14.73; p = 0.028), while SQRQ was almost stable in patients with stable or improved DLCO. Patients who died had a significant greater increase in SGRQ total scores (mean 11.8 ± 18.6) at their last follow-up visit prior to death compared to survivors (mean 4.2 ± 18.9; HR = 1.03; 95% CI: 1.01 to 1.04; p < 0.001). All QoL scores across the follow-up period were significantly worse in hospitalised patients compared to non-hospitalised patients, with the worst scores reported in those hospitalised for acute exacerbations. Conclusions QoL assessments in the INSIGHTS-IPF registry demonstrate a close relationship between QoL and clinically meaningful changes in lung function, comorbidities, disease duration and clinical course of IPF, including hospitalisation and mortality. Electronic supplementary material The online version of this article (10.1186/s12931-019-1020-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael Kreuter
- Center for interstitial and rare lung diseases, Thoraxklinik, University of Heidelberg, Röntgenstr 1, D-69126, Heidelberg, Germany. .,German Center for Lung Research, gießen, Germany.
| | - Jeff Swigris
- Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA
| | - David Pittrow
- Institut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - Silke Geier
- Department Market Access, Boehringer Ingelheim, Ingelheim am Rhein, Germany
| | - Jens Klotsche
- Epidemiologie, Deutsches Rheuma-Forschungsinstitut, Berlin, Germany
| | - Antje Prasse
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Germany.,Fraunhofer Institute ITEM, Hannover, Germany.,German Center for Lung Research, gießen, Germany
| | - Hubert Wirtz
- Abteilung für Pneumologie, Department Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Leipzig, Germany
| | - Dirk Koschel
- Zentrum für Pneumologie und Bereich Pneumologie, Fachkrankenhaus Coswig und Uniklinikum Dresden, Coswig, Germany
| | - Stefan Andreas
- Lungenfachklinik Immenhausen and Universitätsmedizin Göttingen, Kardiologie und Pneumologie, Göttingen, Germany
| | - Martin Claussen
- Lungen Clinic Grosshansdorf, Grosshansdorf, Germany.,German Center for Lung Research, gießen, Germany
| | | | - Henrike Wilkens
- Klinik für Innere Medizin V, Pneumologie, Universitätsklinikum Universitätskliniken des Saarlandes, Homburg, Germany
| | | | - Dirk Skowasch
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Joachim F Meyer
- Lungenzentrum München, LZM Bogenhausen-Harlaching, Städtisches Klinikum München GmbH, Munich, Germany
| | | | - Sven Gläser
- Klinik und Poliklinik für Innere Medizin B, Forschungsbereich Pneumologie und Pneumologische Epidemiologie, Universitätsmedizin Greifswald, Greifswald, Germany.,Vivantes Klinikum Spandau, Klinik für Innere Medizin, Berlin, Germany
| | - Nicolas Kahn
- Center for interstitial and rare lung diseases, Thoraxklinik, University of Heidelberg, Röntgenstr 1, D-69126, Heidelberg, Germany.,German Center for Lung Research, gießen, Germany
| | - Tobias Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Germany.,German Center for Lung Research, gießen, Germany
| | - Claus Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der LMU, Munich, Germany.,Schillerhöhe, Robert Bosch Krankenhaus, Stuttgart, Germany
| | | | - Matthias Held
- Klinikum Würzburg Mitte, Standort Missioklinik, Abteilung Innere Medizin, Pneumologie, Würzburg, Germany
| | - Thomas Bahmer
- Lungen Clinic Grosshansdorf, Grosshansdorf, Germany.,German Center for Lung Research, gießen, Germany
| | - Tim Oqueka
- Universitätsklinikum Hamburg, Hamburg, Germany
| | - Marion Frankenberger
- Medizinische Klinik und Poliklinik V, Klinikum der LMU, Munich, Germany.,Asklepios Fachkliniken München-Gauting, Munich, Germany.,German Center for Lung Research, gießen, Germany
| | - Jürgen Behr
- Medizinische Klinik und Poliklinik V, Klinikum der LMU, Munich, Germany.,Asklepios Fachkliniken München-Gauting, Munich, Germany.,German Center for Lung Research, gießen, Germany
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Kolb M, Vašáková M. The natural history of progressive fibrosing interstitial lung diseases. Respir Res 2019; 20:57. [PMID: 30871560 PMCID: PMC6417262 DOI: 10.1186/s12931-019-1022-1] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/04/2019] [Indexed: 12/11/2022] Open
Abstract
A proportion of patients with certain types of interstitial lung disease (ILD), including chronic hypersensitivity pneumonitis and ILDs associated with autoimmune diseases, develop a progressive fibrosing phenotype that shows similarities in clinical course to idiopathic pulmonary fibrosis. Irrespective of the clinical diagnosis, these progressive fibrosing ILDs show commonalities in the underlying pathogenetic mechanisms that drive a self-sustaining process of pulmonary fibrosis. The natural history of progressive fibrosing ILDs is characterized by decline in lung function, worsening of symptoms and health-related quality of life, and early mortality. Greater impairment in forced vital capacity or diffusion capacity of the lungs for carbon monoxide, and a greater extent of fibrotic changes on a computed tomography scan, are predictors of mortality in patients with fibrosing ILDs. However, the course of these diseases is heterogenous and cannot accurately be predicted for an individual patient. Data from ongoing clinical trials and patient registries will provide a better understanding of the clinical course and impact of progressive fibrosing ILDs.
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Affiliation(s)
- Martin Kolb
- McMaster University and St. Joseph’s Healthcare, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6 Canada
| | - Martina Vašáková
- Department of Respiratory Medicine, Thomayer Hospital, Videnska 800, 14059 Prague, Czech Republic
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Bouros D, Daniil Z, Papakosta D, Antoniou KM, Markopoulou K, Kolilekas L, Konstantopoulos G, Papiris S. Design, Rationale, Methodology, and Aims of a Greek Prospective Idiopathic Pulmonary Fibrosis Registry: Investigating Idiopathic Pulmonary Fibrosis in Greece (INDULGE IPF). Respiration 2018; 96:41-47. [PMID: 29514162 DOI: 10.1159/000487244] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a chronic, fibrosing interstitial pneumonia of unknown origin. Despite the fact that the guidelines on the diagnosis and management of the disease were updated in 2015, incorporating novel agents recently introduced in the therapeutic approach of IPF, there is a lack of data on the epidemiology, disease status, and treatment in clinical practice. Contemporary data provided by national registries in IPF provide valuable information to guide clinical management of the disease in the real-world setting, adjusted to the local needs. OBJECTIVE Investigating Idiopathic Pulmonary Fibrosis in Greece (INDULGE IPF) is a Greek observational registry aiming at gaining further knowledge on the characteristics, management, progression, and outcomes of patients with IPF treated under real-world, clinical practice conditions in Greece. METHODS Approximately 300 patients will be enrolled consecutively in seven reference centers, constituting the largest IPF registry ever established in Greece. CONCLUSION This registry is expected to provide data on the characteristics of IPF patients in Greece and the entire clinical management during the course of the disease.
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Affiliation(s)
- Demosthenes Bouros
- 1st Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoe Daniil
- Respiratory Medicine Department, University of Thessaly School of Medicine, University Hospital of Larissa, Larissa, Greece
| | - Despoina Papakosta
- Pulmonary Medicine Department, General Hospital of Thessaloniki "G. Papanikolaou," Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - Katerina M Antoniou
- Thoracic Medicine Department, University Hospital of Heraklion, Heraklion, Greece
| | - Katerina Markopoulou
- NHS Pulmonology Department, General Hospital of Thessaloniki "G. Papanikolaou,", Thessaloniki, Greece
| | - Likurgos Kolilekas
- NHS 7th Pulmonary Department and Asthma Center, Hospital for Diseases of the Chest "Sotiria,", Athens, Greece
| | | | - Spyros Papiris
- 2nd Respiratory Medicine Department, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
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8
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Ferrara G, Luppi F, Birring SS, Cerri S, Caminati A, Sköld M, Kreuter M. Best supportive care for idiopathic pulmonary fibrosis: current gaps and future directions. Eur Respir Rev 2018; 27:27/147/170076. [PMID: 29436402 DOI: 10.1183/16000617.0076-2017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/25/2017] [Indexed: 11/05/2022] Open
Abstract
Best supportive care (BSC) is generally defined as all the interventions and the multiprofessional approach aimed to improve and optimise quality of life (QoL) in patients affected by progressive diseases. In this sense, it excludes and might be complementary to other interventions directly targeting the disease. BSC improves survival in patients with different types of cancer. Patients with idiopathic pulmonary fibrosis (IPF) experience a vast range of symptoms during the natural history of the disease and might have a beneficial effect of BSC interventions. This review highlights the current evidence on interventions targeting QoL and gaps for the clinical assessment of BSC in the treatment of IPF patients. Very few interventions to improve QoL or improve symptom control are currently supported by well-designed studies. Sound methodology is paramount in evaluating BSC in IPF, as well as the use of validated tools to measure QoL and symptom control in this specific group of patients.
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Affiliation(s)
- Giovanni Ferrara
- Section of Respiratory Medicine, Dept of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden .,Division of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Fabrizio Luppi
- Center for Rare Lung Diseases, University Hospital of Modena, Modena, Italy
| | - Surinder S Birring
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Stefania Cerri
- Center for Rare Lung Diseases, University Hospital of Modena, Modena, Italy
| | - Antonella Caminati
- Section of Respiratory Medicine, San Giuseppe Hospital Multimedica, Milan, Italy
| | - Magnus Sköld
- Section of Respiratory Medicine, Dept of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Division of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Michael Kreuter
- University of Heidelberg and Center for Interstitial and Rare Lung Disease, Division of Respiratory Medicine, University of Heidelberg, Heidelberg, Germany
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New insights on patient-reported outcome measures in idiopathic pulmonary fibrosis: only PROMises? Curr Opin Pulm Med 2017; 22:434-41. [PMID: 27333428 DOI: 10.1097/mcp.0000000000000294] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW In a chronic, progressive and ultimately fatal disease like idiopathic pulmonary fibrosis (IPF), the maintenance of patients' quality of life should be regarded as a major aim of treatment. Although better knowledge and two antifibrotic drugs are now available in IPF, the individual response to treatment and its acceptance remain poorly explored. This review summarizes recent advances in research on patient-reported outcomes and their measures, indispensable instruments to investigate how patients feel and function, and how the disease impacts their lives. RECENT FINDINGS In IPF, there is a paucity of specific well-validated patient-reported outcome measures (PROMs). The use of generic PROMs in past IPF trials revealed a poor correlation of such questionnaires with established endpoints of treatment response. Several attempts are currently ongoing to develop specific IPF PROMs. The King's Brief Interstitial Lung Disease health status questionnaire and the Tool to Assess Quality of Life in IPF are promising questionnaires developed by using institutional recommendations and are currently being validated in large cohorts. SUMMARY Well-validated relevant PROMs can be employed for multiple purposes: as outcome measures for daily care or for driving therapeutic decisions, as efficacy endpoints in clinical trials, or as tools to collect useful data for healthcare policy makers in order to improve access and quality of care.
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10
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Singh S, Collins BF, Sharma BB, Joshi JM, Talwar D, Katiyar S, Singh N, Ho L, Samaria JK, Bhattacharya P, Gupta R, Chaudhari S, Singh T, Moond V, Pipavath S, Ahuja J, Chetambath R, Ghoshal AG, Jain NK, Devi HJG, Kant S, Koul P, Dhar R, Swarnakar R, Sharma SK, Roy DJ, Sarmah KR, Jankharia B, Schmidt R, Katiyar SK, Jindal A, Mangal DK, Singh V, Raghu G. Interstitial Lung Disease in India. Results of a Prospective Registry. Am J Respir Crit Care Med 2017; 195:801-813. [PMID: 27684041 DOI: 10.1164/rccm.201607-1484oc] [Citation(s) in RCA: 127] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Interstitial lung disease (ILD) is a heterogeneous group of acute and chronic inflammatory and fibrotic lung diseases. Existing ILD registries have had variable findings. Little is known about the clinical profile of ILDs in India. OBJECTIVES To characterize new-onset ILDs in India by creating a prospective ILD using multidisciplinary discussion (MDD) to validate diagnoses. METHODS Adult patients of Indian origin living in India with new-onset ILD (27 centers, 19 Indian cities, March 2012-June 2015) without malignancy or infection were included. All had connective tissue disease (CTD) serologies, spirometry, and high-resolution computed tomography chest. ILD pattern was defined by high-resolution computed tomography images. Three groups independently made diagnoses after review of clinical data including that from prompted case report forms: local site investigators, ILD experts at the National Data Coordinating Center (NDCC; Jaipur, India) with MDD, and experienced ILD experts at the Center for ILD (CILD; Seattle, WA) with MDD. Cohen's κ was used to assess reliability of interobserver agreement. MEASUREMENTS AND MAIN RESULTS A total of 1,084 patients were recruited. Final diagnosis: hypersensitivity pneumonitis in 47.3% (n = 513; exposure, 48.1% air coolers), CTD-ILD in 13.9%, and idiopathic pulmonary fibrosis in 13.7%. Cohen's κ: 0.351 site investigator/CILD, 0.519 site investigator/NDCC, and 0.618 NDCC/CILD. CONCLUSIONS Hypersensitivity pneumonitis was the most common new-onset ILD in India, followed by CTD-ILD and idiopathic pulmonary fibrosis; diagnoses varied between site investigators and CILD experts, emphasizing the value of MDD in ILD diagnosis. Prompted case report forms including environmental exposures in prospective registries will likely provide further insight into the etiology and management of ILD worldwide.
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Affiliation(s)
| | | | | | - Jyotsna M Joshi
- 4 Department of Pulmonary Medicine, Topiwala National Medical College & BYL Nair Hospital, Mumbai, India
| | - Deepak Talwar
- 5 Department of Pulmonary and Sleep Care Medicine, Metro Multispeciality Hospital, Noida, India
| | - Sandeep Katiyar
- 6 Department of Respiratory Medicine, Chest Care Centre, Kanpur, India
| | | | | | - Jai Kumar Samaria
- 8 Department of Chest Disease, Banaras Hindu University, Varanasi, India
| | | | - Rakesh Gupta
- 10 Department of Respiratory Medicine, JLN Medical College & Hospital, Ajmer, India
| | - Sudhir Chaudhari
- 11 Department of Chest and Tuberculosis, GSVM Medical College, Kanpur, India
| | - Tejraj Singh
- 12 Research Division, Asthma Bhawan, Jaipur, India
| | | | | | | | - Ravindran Chetambath
- 15 Department of Pulmonary Medicine, Government Medical College, Kozhikode, India
| | - Aloke G Ghoshal
- 16 National Allergy Asthma Bronchitis Institute, Kolkata, India
| | - Nirmal K Jain
- 17 Department of Respiratory Medicine, SoniManipal Hospital, Jaipur, India
| | - H J Gayathri Devi
- 18 Department of Chest Medicine, MS Ramaiah Medical College, Bangalore, India
| | - Surya Kant
- 19 Department of Pulmonary Medicine, King George's Medical University, Lucknow, India
| | - Parvaiz Koul
- 20 Department of Internal and Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Raja Dhar
- 21 Department of Pulmonology & Critical Care, Fortis Hospital, Kolkata, India
| | - Rajesh Swarnakar
- 22 Department of Pulmonology and Respiratory Medicine, Getwell Hospital and Research Institute, Nagpur, India
| | - Surendra K Sharma
- 23 Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Dhrubajyoti J Roy
- 24 Department of Respiratory Medicine, Pulmonary and Sleep Clinic, Kolkata, India
| | - Kripesh R Sarmah
- 25 Department of Pulmonary Medicine, Gauhati Medical College, Guwahati, India
| | - Bhavin Jankharia
- 26 Department of Radiology, Jankharia Imaging, Mumbai, India; and
| | - Rodney Schmidt
- 27 Department of Pathology, Center for Interstitial Lung Diseases, University of Washington, Seattle, Washington
| | - Santosh K Katiyar
- 6 Department of Respiratory Medicine, Chest Care Centre, Kanpur, India
| | - Arpita Jindal
- 28 Department of Pathology, SMS Medical College, Jaipur, India
| | - Daya K Mangal
- 29 Department of Research, IIHMR University, Jaipur, India
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11
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Kreuter M, Swigris J, Pittrow D, Geier S, Klotsche J, Prasse A, Wirtz H, Koschel D, Andreas S, Claussen M, Grohé C, Wilkens H, Hagmeyer L, Skowasch D, Meyer JF, Kirschner J, Gläser S, Herth FJF, Welte T, Neurohr C, Schwaiblmair M, Held M, Bahmer T, Frankenberger M, Behr J. Health related quality of life in patients with idiopathic pulmonary fibrosis in clinical practice: insights-IPF registry. Respir Res 2017; 18:139. [PMID: 28709421 PMCID: PMC5512739 DOI: 10.1186/s12931-017-0621-y] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 07/03/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The INSIGHTS-IPF registry provides one of the largest data sets of clinical data and self-reported patient related outcomes including health related quality of life (QoL) on patients with idiopathic pulmonary fibrosis (IPF). We aimed to describe associations of various QoL instruments between each other and with patient characteristics at baseline. METHODS Six hundred twenty-three IPF patients with available QoL data (St George's Respiratory Questionnaire SGRQ, UCSD Shortness-of-Breath Questionnaire SoB, EuroQol visual analogue scale and index EQ-5D, Well-being Index WHO-5) were analysed. Mean age was 69.6 ± 8.7 years, 77% were males, mean disease duration 2.0 ± 3.3 years, FVC pred was 67.5 ± 17.8%, DLCO pred 35.6 ± 17%. RESULTS Mean points were SGRQ total 48.3, UCSD SoB 47.8, EQ-5D VAS 66.8, and WHO-5 13.9. These instruments had a high or very high correlation (exception WHO-5 to EQ-5D VAS with moderate correlation). On bivariate analysis, QoL by SGRQ total was statistically significantly associated with clinical symptoms (NYHA; p < 0.001), number of comorbidities (p < 0.05), hospitalisation rate (p < 0.01) and disease severity (as measured by GAP score, CPI, FVC and 6-min walk test; p < 0.05 each). Multivariate analyses showed a significant association between QoL (by SGRQ total) and IPF duration, FVC, age, NYHA class and indication for long-term oxygen treatment. CONCLUSIONS Overall, IPF patients under real-life conditions have lower QoL compared to those in clinical studies. There is a meaningful relationship between QoL and various patient characteristics. TRIAL REGISTRATION The INSIGHTS-IPF registry is registered at Clinicaltrials.gov ( NCT01695408 ).
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Affiliation(s)
- Michael Kreuter
- Center for interstitial and rare lung diseases, pneumology and respiratory critical care medicine, Thoraxklinik, University of Heidelberg, Röntgenstr. 1, D-69126 Heidelberg, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
| | - Jeff Swigris
- Interstitial Lung Disease Program, National Jewish Health, Denver, CO USA
| | - David Pittrow
- Institut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - Silke Geier
- Department Market Access, Boehringer Ingelheim, Ingelheim am Rhein, Germany
| | - Jens Klotsche
- Epidemiologie, Deutsches Rheuma-Forschungsinstitut, Berlin, Germany
| | - Antje Prasse
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Germany
- Fraunhofer Institute ITEM, Hannover, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
| | - Hubert Wirtz
- Abteilung für Pneumologie, Department Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Leipzig, Germany
| | - Dirk Koschel
- Zentrum für Pneumologie, Fachkrankenhaus Coswig, Coswig, Germany
| | - Stefan Andreas
- Lungenfachklinik Immenhausen and Universitätsmedizin Göttingen, Kardiologie und Pneumologie, Göttingen, Germany
| | - Martin Claussen
- LungenClinic Grosshansdorf, Grosshansdorf, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
| | | | - Henrike Wilkens
- Klinik für Innere Medizin V, Pneumologie, Universitätsklinikum Universitätskliniken des Saarlandes, Homburg, Germany
| | | | - Dirk Skowasch
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Joachim F Meyer
- Lungenzentrum München, LZM Bogenhausen-Harlaching, Städtisches Klinikum München GmbH, München, Germany
| | | | - Sven Gläser
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Innere Medizin B, Forschungsbereich Pneumologie und Pneumologische Epidemiologie, Greifswald, Germany
- Vivantes Klinikum Spandau, Klinik für Innere Medizin, Berlin, Germany
| | - Felix J. F. Herth
- Center for interstitial and rare lung diseases, pneumology and respiratory critical care medicine, Thoraxklinik, University of Heidelberg, Röntgenstr. 1, D-69126 Heidelberg, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
| | - Tobias Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
| | - Claus Neurohr
- Comprehensive Pneumology Center, Lungenforschungsambulanz, Klinikum der Universität München, München, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
| | | | - Matthias Held
- Klinikum Würzburg Mitte, Standort Missioklinik, Abteilung Innere Medizin, Pneumologie, Würzburg, Germany
| | - Thomas Bahmer
- LungenClinic Grosshansdorf, Grosshansdorf, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
| | - Marion Frankenberger
- Comprehensive Pneumology Center, Lungenforschungsambulanz, Klinikum der Universität München, München, Germany
- Asklepios Fachkliniken München-Gauting, München, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
| | - Jürgen Behr
- Comprehensive Pneumology Center, Lungenforschungsambulanz, Klinikum der Universität München, München, Germany
- Asklepios Fachkliniken München-Gauting, München, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
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Nakamura Y, Suda T. Idiopathic Pulmonary Fibrosis: Diagnosis and Clinical Manifestations. Clin Med Insights Circ Respir Pulm Med 2016; 9:163-71. [PMID: 27625576 PMCID: PMC5013866 DOI: 10.4137/ccrpm.s39897] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/03/2016] [Accepted: 07/05/2016] [Indexed: 12/16/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a parenchymal lung disease characterized by progressive interstitial fibrosis. The clinical course of IPF can be unpredictable and may be punctuated by acute exacerbations. Although much progress is being made in unraveling the mechanisms underlying IPF, effective therapy for improving survival remains elusive. Longitudinal disease profiling, especially in terms of clinical manifestations in a large cohort of patients, should lead to proper management of the patients and development of new treatments for IPF. Appropriate multidisciplinary assessment in ongoing registries is required to achieve this. This review summarizes the current status of the diagnosis and clinical manifestations of IPF.
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Affiliation(s)
- Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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13
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O'Brien EC, Durheim MT, Gamerman V, Garfinkel S, Anstrom KJ, Palmer SM, Conoscenti CS. Rationale for and design of the Idiopathic Pulmonary Fibrosis-PRospective Outcomes (IPF-PRO) registry. BMJ Open Respir Res 2016; 3:e000108. [PMID: 26835134 PMCID: PMC4716211 DOI: 10.1136/bmjresp-2015-000108] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/09/2015] [Accepted: 12/12/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease characterised by progressive loss of lung function. Its clinical course is variable but ultimately fatal. There is a need for a multicentre patient registry incorporating longitudinal clinical data and biological samples to improve understanding of the natural history of IPF and contemporary practice patterns. METHODS/DESIGN The Idiopathic Pulmonary Fibrosis-PRospective Outcomes (IPF-PRO) registry is a national IPF registry in the USA. This registry will enrol approximately 300 patients with newly diagnosed IPF over 2 years at approximately 14 tertiary pulmonary care sites. Participants will be followed for 3-5 years and will receive usual care, as defined by their physician. Clinical data from the year prior to diagnosis will be collected from medical record review on enrolment. Subsequently, data on diagnostic evaluations, pulmonary function tests, physical examinations, laboratory data and clinical events will be collected at routine clinical visits and via a call centre. Participants will complete patient-reported outcome questionnaires at enrolment and then at approximately 6-month intervals. Blood samples for cellular, genetic and transcriptomic analyses will be collected at the same intervals. RESULTS The first results from the IPF-PRO registry will be presented in 2015. CONCLUSIONS The IPF-PRO registry will improve understanding of the natural history of IPF, its impact on patients and current practice in the diagnosis and care of patients with IPF. The registry will establish a repository of biological samples from a well-characterised patient population for future research. CLINICAL TRIAL NUMBER NCT01915511.
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Affiliation(s)
- Emily C O'Brien
- Department of Medicine, Duke University, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Michael T Durheim
- Department of Medicine, Duke University, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Victoria Gamerman
- Biometrics and Data Management, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut, USA
| | - Sandy Garfinkel
- Clinical Operations, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut, USA
| | - Kevin J Anstrom
- Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Scott M Palmer
- Department of Medicine, Duke University, Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Craig S Conoscenti
- Clinical Development and Medical Affairs, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut, USA
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14
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Raghu G, Mehta S. Interstitial lung disease (ILD) in India: Insights and lessons from the prospective, landmark ILD-India registry. Lung India 2016; 33:589-591. [PMID: 27890985 PMCID: PMC5112813 DOI: 10.4103/0970-2113.192874] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Ganesh Raghu
- Department of Medicine, Center for Interstitial Lung Diseases, UW Medicine, University of Washington, Seattle, WA, USA. E-mail:
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15
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Fregonese L, Eichler I. The future of the development of medicines in idiopathic pulmonary fibrosis. BMC Med 2015; 13:239. [PMID: 26399608 PMCID: PMC4581513 DOI: 10.1186/s12916-015-0480-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/03/2015] [Indexed: 01/13/2023] Open
Abstract
The development of treatments for idiopathic pulmonary fibrosis (IPF) has been often disappointing. Building on authorized treatments that can benchmark the validity of treatment effect measures, the time has come to standardize endpoints and achieve consensus on their use for different clinical questions and specific IPF phenotypes. In order to facilitate the development of new medicines for IPF it is crucial that the knowledge of the disease and lessons learnt from past trials are taken forward to create international trial networks with involvement of patients, including biobanks and clinical data collection through a multinational registry. Interaction with regulators may be useful to align the initiatives of academia and pharmaceutical companies with the bodies ultimately responsible for licensing new products. Interaction can occur through the use of qualification programs for biomarkers and endpoints, and participation in innovative regulatory pathways and initiatives. Finally, the experience of IPF should be used to benefit even rarer interstitial lung diseases for which no treatment is available, including pediatric interstitial lung diseases. This commentary provides a perspective on the hurdles slowing the development and regulatory approval of medicines for IPF, and encourages close cooperation between investigators and drug regulators.
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Affiliation(s)
- Laura Fregonese
- Orphan Medicines Office, European Medicines Agency, 30 Churchill Place, Canary Wharf, E14 5EU, London, UK.
| | - Irmgard Eichler
- Paediatric Medicines Office, European Medicines Agency, London, UK
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16
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Behr J, Kreuter M, Hoeper MM, Wirtz H, Klotsche J, Koschel D, Andreas S, Claussen M, Grohé C, Wilkens H, Randerath W, Skowasch D, Meyer FJ, Kirschner J, Gläser S, Herth FJF, Welte T, Huber RM, Neurohr C, Schwaiblmair M, Kohlhäufl M, Höffken G, Held M, Koch A, Bahmer T, Pittrow D. Management of patients with idiopathic pulmonary fibrosis in clinical practice: the INSIGHTS-IPF registry. Eur Respir J 2015; 46:186-96. [PMID: 25837040 PMCID: PMC4486374 DOI: 10.1183/09031936.00217614] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 02/03/2015] [Indexed: 11/26/2022]
Abstract
After introduction of the new international guidelines on idiopathic pulmonary fibrosis (IPF) in 2011, we investigated clinical management practices for patients with IPF according to physicians' diagnoses. A prospective, multicenter, noninterventional study with comprehensive quality measures including on-site source data verification was performed in Germany. 502 consecutive patients (171 newly diagnosed, 331 prevalent; mean±SD age 68.7±9.4 years, 77.9% males) with a mean disease duration of 2.3±3.5 years were enrolled. IPF diagnosis was based on clinical assessments and high-resolution computed tomography (HRCT) in 90.2%, and on surgical lung biopsy combined with histology in 34.1% (lavage in 61.8%). The median 6-min walk distance was 320 m (mean 268±200 m). The mean forced vital capacity was 72±20% pred and diffusing capacity of the lung for carbon monoxide was 35±15% pred. No drugs were administered in 17.9%, oral steroids in 23.7%, N-acetylcysteine in 33.7%, pirfenidone in 44.2% and other drugs in 4.6% of patients. Only 2.8% of the cohort was listed for lung transplantation. IPF patients were diagnosed in line with the new guidelines. They had more severe disease than those enrolled in recent randomised controlled trials. In addition to HRCT, the frequency of lung biopsies was surprisingly high. Treatment patterns varied substantially.
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Affiliation(s)
| | | | | | | | | | - Dirk Koschel
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Stefan Andreas
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Martin Claussen
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Christian Grohé
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Henrike Wilkens
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Winfried Randerath
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Dirk Skowasch
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - F Joachim Meyer
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Joachim Kirschner
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Sven Gläser
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Felix J F Herth
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Tobias Welte
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Rudolf Maria Huber
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Claus Neurohr
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Martin Schwaiblmair
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Martin Kohlhäufl
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Gert Höffken
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Matthias Held
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Andrea Koch
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Thomas Bahmer
- For the authors' affiliations, see the Acknowledgements Study steering committee members
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