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Eaden JA, Barber CM, Renshaw SA, Chaudhuri N, Bianchi SM. Real world experience of response to pirfenidone in patients with idiopathic pulmonary fibrosis: a two centre retrospective study. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2020; 37:218-224. [PMID: 33093786 PMCID: PMC7569563 DOI: 10.36141/svdld.v37i2.8587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/15/2020] [Indexed: 11/17/2022]
Abstract
Introduction: Pirfenidone has been shown to reduce the decline in forced vital capacity (FVC) compared to placebo in patients with idiopathic pulmonary fibrosis (IPF). Previous studies have suggested that patients with a more rapid decline in FVC during the period before starting pirfenidone experience the greatest benefit from treatment. The purpose of this retrospective observational study was to investigate the response to pirfenidone in IPF patients, comparing two groups stratified by the annual rate of decline in FVC % predicted prior to treatment. Methods: Using the rate of decline in FVC % predicted in the 12 months prior to pirfenidone, patients were stratified into slow (<5%) or rapid (≥5%) decliner groups. Comparisons in the lung function response to pirfenidone in these two groups were performed. Results: Pirfenidone resulted in no statistically significant reduction in the median annual rate of decline in FVC or FVC % predicted. In the rapid decliners, pirfenidone significantly reduced the median (IQR) annual rate of decline in FVC % predicted (-8.7 (-14.2 – -7.0) %/yr vs 2.0 (-7.1 – 6.0) %/yr; n=17; p<0.01). In the slow decliners, pirfenidone did not reduce the median (IQR) annual rate of decline in FVC % predicted (-1.3 (-3.2 – 1.3) %/yr vs -5.0 (-8.3 – -0.35) %/yr; n=17; p=0.028). Conclusions: We demonstrate the greater net effect of pirfenidone in IPF patients declining rapidly. We suggest that using an annual rate of decline in FVC of <5% and ≥5% may be useful in counselling patients with regard to pirfenidone treatment. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 218-224)
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Affiliation(s)
- James A Eaden
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Respiratory Medicine Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Christopher M Barber
- Respiratory Medicine Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Stephen A Renshaw
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Respiratory Medicine Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Nazia Chaudhuri
- Interstitial Lung Disease Unit, University of Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Stephen M Bianchi
- Respiratory Medicine Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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Antifibrotic treatment improves clinical outcomes in patients with idiopathic pulmonary fibrosis: a propensity score matching analysis. Sci Rep 2020; 10:15620. [PMID: 32973215 PMCID: PMC7515864 DOI: 10.1038/s41598-020-72607-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/03/2020] [Indexed: 11/08/2022] Open
Abstract
In patients with idiopathic pulmonary fibrosis (IPF), the effects of antifibrotic agents on the prognosis remain unclear. This study aimed to investigate the impact of antifibrotic treatment on the risks of mortality, hospitalisation, and acute exacerbation in real-world patients with IPF. A total of 1213 IPF patients (biopsy-proven cases: 405) were included in this retrospective study. Propensity score matching was used to adjust for differences in baseline characteristics between patients who received antifibrotic treatment and who did not. A Cox proportional hazard model was used to compare the risks of all-cause mortality, hospitalisation, acute exacerbation, and mortality following acute exacerbation between the two groups. From the 1213 patients, 474 matched pairs were generated. The mean age of the patients in the matched cohort was 65.8 years and 82.8% were men. The median follow-up duration was 27 months. Antifibrotic treatment significantly reduced the risks of mortality [hazard ratio (HR), 0.59; 95% confidence interval (CI), 0.48-0.72; p < 0.001], all-cause hospitalisation (HR 0.71), respiratory-related hospitalisation (HR 0.67), acute exacerbation (HR 0.69), and mortality after acute exacerbation (HR 0.60). Our results suggest that antifibrotic treatment may reduce the risks of all-cause mortality, hospitalisation, acute exacerbation, and mortality after acute exacerbation in patients with IPF.
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Cameli P, Refini RM, Bergantini L, d'Alessandro M, Alonzi V, Magnoni C, Rottoli P, Sestini P, Bargagli E. Long-Term Follow-Up of Patients With Idiopathic Pulmonary Fibrosis Treated With Pirfenidone or Nintedanib: A Real-Life Comparison Study. Front Mol Biosci 2020; 7:581828. [PMID: 33102528 PMCID: PMC7498677 DOI: 10.3389/fmolb.2020.581828] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/13/2020] [Indexed: 12/14/2022] Open
Abstract
Background Pirfenidone and nintedanib are the sole pharmacological therapies currently approved for idiopathic pulmonary fibrosis (IPF). Limited comparison data is available in literature, despite they are both prescribed for mild-to-moderate disease. Here, we describe our almost 10 years real-life experience with antifibrotic treatment to investigate potential differences in terms of efficacy. Population and Methods We retrospectively recruited patients diagnosed with IPF and treated with pirfenidone or nintedanib at Siena Referral Center. Clinical, functional, safety and radiological data was collected at baseline and during the follow-up, according to our Center protocol. Results We retrospectively recruited 263 IPF patients (139 treated with pirfenidone and 124 with nintedanib) in the study. After 885.3 ± 559.5 days of observation, the median survival was 1224 days. No significant differences were found between pirfenidone and nintedanib in terms of survival and time to decline of forced vital capacity >10% (p = 0.8786 and p = 0.1677, respectively). A smaller lung diffusion for carbon monoxide (DLCO) decrease was found after 1 year of therapy with nintedanib in respect to pirfenidone (p = 0.0167). Overall, 21 patients permanently discontinued antifibrotic treatment due to side effects (14 with pirfenidone, 7 with nintedanib); no fatal adverse events were recorded. Discussion Our results showed a similar effectiveness between pirfenidone and nintedanib in terms of mortality and functional disease progression. Both drugs confirmed their good tolerability profile and no new safety alerts were observed. Nintedanib was associated with a smaller reduction of DLCO after 1 year of follow-up compared with pirfenidone, maybe due to its antiangiogenic properties.
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Affiliation(s)
- Paolo Cameli
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Rosa Metella Refini
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Laura Bergantini
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Miriana d'Alessandro
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Valerio Alonzi
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Carlo Magnoni
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Paola Rottoli
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Piersante Sestini
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Elena Bargagli
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
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Majewski S, Białas AJ, Buchczyk M, Gomółka P, Górska K, Jagielska-Len H, Jarzemska A, Jassem E, Jastrzębski D, Kania A, Koprowski M, Krenke R, Kuś J, Lewandowska K, Martusewicz-Boros MM, Roszkowski-Śliż K, Siemińska A, Sładek K, Sobiecka M, Szewczyk K, Tomczak M, Tomkowski W, Wiatr E, Ziora D, Żołnowska B, Piotrowski WJ. A multicentre retrospective observational study on Polish experience of pirfenidone therapy in patients with idiopathic pulmonary fibrosis: the PolExPIR study. BMC Pulm Med 2020; 20:122. [PMID: 32366291 PMCID: PMC7199354 DOI: 10.1186/s12890-020-1162-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pirfenidone is an antifibrotic agent approved for the treatment of idiopathic pulmonary fibrosis (IPF). The drug is available for Polish patients with IPF since 2017. The PolExPIR study aimed to describe the real-world data (RWD) on the Polish experience of pirfenidone therapy in IPF with respect to safety and efficacy profiles. METHODS This was a multicentre, retrospective, observational study collecting clinical data of patients with IPF receiving pirfenidone from January 2017 to September 2019 across 10 specialized pulmonary centres in Poland. Data collection included baseline characteristics, pulmonary function tests (PFTs) results and six-minute walk test (6MWT). Longitudinal data on PFTs, 6MWT, adverse drug reactions (ADRs), treatment persistence, and survival were also collected up to 24 months post-inclusion. RESULTS A total of 307 patients receiving pirfenidone were identified for analysis. The mean age was 68.83 (8.13) years and 77% were males. The median time from the first symptoms to IPF diagnosis was 15.5 (9.75-30) months and from diagnosis to start of pirfenidone treatment was 6 (2-23) months. Patients were followed on treatment for a median of 17 (12-22.75) months. Seventy-four patients (24.1%) required dose adjustments and 35 (11.4%) were chronically treated with different than the full recommended dose. A total of 141 patients (45.92%) discontinued therapy due to different reasons including ADRs (16.61%), death (8.79%), disease progression (6.51%), patient's own request (5.54%), neoplastic disease (3.91%) and lung transplantation (0.33%). Over up to 24 months of follow-up, the pulmonary function remained largely stable. The median annual decline in forced vital capacity (FVC) during the first year of pirfenidone therapy was -20 ml (-200-100) and during the second year was -120 ml (-340-30). Over a study period, 33 patients (10.75%) died. CONCLUSIONS The PolExPIR study is a source of longitudinal RWD on pirfenidone therapy in the Polish cohort of patients with IPF supporting its long-term acceptable safety and efficacy profiles and reinforce findings from the previous randomised clinical trials and observational studies.
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Affiliation(s)
- Sebastian Majewski
- Department of Pneumology and Allergy, Medical University of Lodz, Lodz, Poland.
| | - Adam J Białas
- Department of Pathobiology of Respiratory Diseases, Medical University of Lodz, Lodz, Poland
| | - Małgorzata Buchczyk
- Department of Lung Diseases and Tuberculosis, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Paweł Gomółka
- Department of Pulmonology, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna Górska
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Hanna Jagielska-Len
- Clinical Department of Lung Diseases, K. Marcinkowski University Hospital, Zielona Gora, Poland
| | - Agnieszka Jarzemska
- Department of Pneumonology, Oncology and Tuberculosis, Kuyavian and Pomeranian Pulmonology Centre, Bydgoszcz, Poland
| | - Ewa Jassem
- Department of Allergology and Pneumonology, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Jastrzębski
- Department of Lung Diseases and Tuberculosis, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Aleksander Kania
- Department of Pulmonology, Jagiellonian University Medical College, Cracow, Poland
| | - Marek Koprowski
- Department of Civilization Diseases and Lung Diseases, John Paul II Specialist Hospital, Cracow, Poland
| | - Rafał Krenke
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Jan Kuś
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Katarzyna Lewandowska
- 1st Department of Lung Diseases, 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
| | - Kazimierz Roszkowski-Śliż
- 3rd Lung Diseases and Oncology Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Alicja Siemińska
- Department of Allergology and Pneumonology, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Sładek
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Sobiecka
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Karolina Szewczyk
- Department of Pathobiology of Respiratory Diseases, Medical University of Lodz, Lodz, Poland
| | - Małgorzata Tomczak
- Department of Pulmonology, E.J. Zeyland Wielkopolska Center of Pulmonology and Thoracic Surgery, Poznan, Poland
| | - Witold Tomkowski
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Elżbieta Wiatr
- 3rd Lung Diseases and Oncology Department, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Dariusz Ziora
- Department of Lung Diseases and Tuberculosis, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Beata Żołnowska
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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The Effectiveness, Safety, and Tolerability of Pirfenidone in Idiopathic Pulmonary Fibrosis: A Retrospective Study. Adv Ther 2019; 36:1126-1131. [PMID: 30900199 DOI: 10.1007/s12325-019-00928-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION In this study we aimed to investigate the effectiveness and safety profile of pirfenidone for the treatment of idiopathic pulmonary fibrosis (IPF) in a real-life setting. METHODS Clinical records of patients diagnosed with mild-to-moderate IPF and receiving pirfenidone treatment across three centers in Turkey between January and September 2017 were retrospectively collected. Pulmonary function measurements, including percentage of forced vital capacity (FVC%) and percentage of diffusion capacity (DLCO%) were analyzed in patients who received pirfenidone treatment for at least 6 months. Decline in lung function, defined as an absolute decline of at least 10% in FVC from baseline, or death at 6 months was also analyzed. Safety data were included for all follow-up visits. RESULTS In the pooled cohort (n = 60), patients were mostly men (73.4%) and current or former smokers (61.7%). Average baseline FVC% and DLCO% were 68.4% and 48.7%, respectively. Forty-seven patients (78.3%) had a high-resolution computed tomography scan with a definite interstitial pneumonia (UIP) pattern, and 18 patients (30%) had a surgically proven UIP pattern. Forty-six (76.7%) patients with IPF remained stable and 14 (23.3%) patients had progressed according to decline in FVC of at least 10% during the therapy course. After 6 months of therapy, cough decreased in 58.3% of patients. At least one side effect due to therapy was encountered in 33 (55.0%) IPF patients. Dyspepsia (36.4%), nausea (27.3%), and rash/photosensitivity (24.2%) were the most frequent side effects in our cohort. Sixteen patients (26.7%) needed dose adjustment, one patient (1.7%) discontinued therapy, and one patient (1.7%) died in the study period. CONCLUSIONS This study shows that pirfenidone seems to be an effective treatment for IPF and also had tolerable and relatively acceptable side effects. FUNDING Roche.
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Zurkova M, Kriegova E, Kolek V, Lostakova V, Sterclova M, Bartos V, Doubkova M, Binkova I, Svoboda M, Strenkova J, Janotova M, Plackova M, Lacina L, Rihak V, Petrik F, Lisa P, Bittenglova R, Tyl R, Ondrejka G, Suldova H, Lnenicka J, Psikalova J, Snizek T, Homolka J, Kralova R, Kervitzer J, Vasakova M. Effect of pirfenidone on lung function decline and survival: 5-yr experience from a real-life IPF cohort from the Czech EMPIRE registry. Respir Res 2019; 20:16. [PMID: 30665416 PMCID: PMC6341650 DOI: 10.1186/s12931-019-0977-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/06/2019] [Indexed: 01/03/2023] Open
Abstract
Introduction Pirfenidone, an antifibrotic drug, slows-down the disease progression in idiopathic pulmonary fibrosis (IPF) over 12 months, however limited data on the decline of lung function and overall survival (OS) in real-world cohorts on longer follow-up exists. Patients/methods Of the enrolled Czech IPF patients (n = 841) from an EMPIRE registry, 383 (45.5%) received pirfenidone, 218 (25.9%) no-antifibrotic treatment and 240 (28.5%) were excluded (missing data, nintedanib treatment). The 2- and 5-yrs OS and forced vital capacity (FVC) and diffusing lung capacity for carbon monoxide (DLCO) were investigated at treatment initiation and 6, 12, 18 and 24 months’ follow-up. Results During a 2-yr follow-up, less than a quarter of the patients progressed on pirfenidone as assessed by the decline of ≥10% FVC (17.0%) and ≥ 15% DLCO (14.3%). On pirfenidone, the DLCO (≥10%) declines at 6, 12, 18 and 24 months’ and DLCO (≥15%) declines at 6, 18 and 24 months’ follow-up were associated with increased mortality. The DLCO decline showed higher predictive value for mortality than FVC decline. In patients with no-antifibrotics, FVC and DLCO declines were not predictive for mortality. Pirfenidone increased 5-yrs OS over no-antifibrotic treatment (55.9% vs 31.5% alive, P = 0.002). Conclusion Our study observed the 2-yrs sustained effect of pirfenidone on the decline of lung function and survival in the real-world patient’s IPF cohort. DLCO decline of ≥10% shows a potential as a mortality predictor in IPF patients on pirfenidone, and should be routinely evaluated during follow-up examinations.
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Affiliation(s)
- Monika Zurkova
- Department of Pulmonary Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Eva Kriegova
- Department of Immunology, Faculty of Medicine and Dentistry, University Hospital Olomouc, Palacky University in Olomouc, Hnevotinska 3, 775 15, Olomouc, Czech Republic.
| | - Vitezslav Kolek
- Department of Pulmonary Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Vladimira Lostakova
- Department of Pulmonary Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Martina Sterclova
- Department of Respiratory Medicine, 1st Faculty of Medicine Charles University in Prague, Thomayer Hospital, Prague, Czech Republic
| | - Vladimir Bartos
- Department of Pulmonary Medicine, Faculty of Medicine in Hradec Kralove at Charles University in Prague, University Hospital Hradec Kralove, Prague, Czech Republic
| | - Martina Doubkova
- Department of Pulmonary Diseases and Tuberculosis, Faculty of Medicine at Masaryk University, University Hospital Brno, Brno, Czech Republic
| | - Ilona Binkova
- Department of Pulmonary Diseases and Tuberculosis, Faculty of Medicine at Masaryk University, University Hospital Brno, Brno, Czech Republic
| | - Michal Svoboda
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jana Strenkova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marketa Janotova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martina Plackova
- Department of Pulmonary Diseases and Tuberculosis, Faculty of Medicine at University of Ostrava, University Hospital Ostrava, Ostrava, Czech Republic
| | - Ladislav Lacina
- Department of Pulmonary Medicine and Thoracic Surgery, Hospital Na Bulovce, Prague, Czech Republic
| | - Vladimir Rihak
- Department of Pulmonary Medicine, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Frantisek Petrik
- Department of Pulmonary Medicine, 2nd Faculty of Medicine at Charles University in Prague, University Hospital in Motol, Prague, Czech Republic
| | - Pavlina Lisa
- Department of Pulmonary Medicine, 2nd Faculty of Medicine at Charles University in Prague, University Hospital in Motol, Prague, Czech Republic
| | - Radka Bittenglova
- Department of Pulmonary Medicine, University Hospital Plzen, Pilsen, Czech Republic
| | - Richard Tyl
- Department of Pulmonary Diseases and Tuberculosis, Faculty of Medicine at University of Ostrava, University Hospital Ostrava, Ostrava, Czech Republic
| | - Gustav Ondrejka
- Department of Pulmonary Medicine, Hospital Novy Jicin, Novy Jicin, Czech Republic
| | - Hana Suldova
- Department of Pulmonary Medicine, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic
| | - Jaroslav Lnenicka
- Department of Pulmonary Diseases and Tuberculosis, Regional Medical Association, JSC - Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Jana Psikalova
- Department of Pulmonary Medicine and Allergology, Hospital Kromeriz, Kromeriz, Czech Republic
| | - Tomas Snizek
- Department of Pulmonary Medicine, Hospital Jihlava, Jihlava, Czech Republic
| | - Jiri Homolka
- Department of Respiratory Medicine, 1st Faculty of Medicine Charles University in Prague, Thomayer Hospital, Prague, Czech Republic
| | - Renata Kralova
- Department of Pulmonary Medicine, Regional Hospital Pardubice, Pardubice, Czech Republic
| | - Jan Kervitzer
- Department of Pulmonary Medicine, Hospital Znojmo, Znojmo, Czech Republic
| | - Martina Vasakova
- Department of Respiratory Medicine, 1st Faculty of Medicine Charles University in Prague, Thomayer Hospital, Prague, Czech Republic
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Harari S, Caminati A, Poletti V, Confalonieri M, Gasparini S, Lacedonia D, Luppi F, Pesci A, Sebastiani A, Spagnolo P, Vancheri C, Balestro E, Bonifazi M, Cerri S, De Giacomi F, Della Porta R, Foschino Barbaro MP, Fui A, Pasquinelli P, Rosso R, Tomassetti S, Specchia C, Rottoli P. A Real-Life Multicenter National Study on Nintedanib in Severe Idiopathic Pulmonary Fibrosis. Respiration 2018; 95:433-440. [PMID: 29587263 DOI: 10.1159/000487711] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/13/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Two therapeutic options are currently available for patients with mild-to-moderate idiopathic pulmonary fibrosis (IPF): pirfenidone and nintedanib. To date, there is still insufficient data on the efficacy of these 2 agents in patients with more severe disease. OBJECTIVES This national, multicenter, retrospective real-life study was intended to determine the impact of nintedanib on the treatment of patients with severe IPF. METHODS All patients included had severe IPF and had to have at least 6 months of follow-up before and at least 6 months of follow-up after starting nintedanib. The aim of the study was to compare the decline in lung function before and after treatment. Patient survival after 6 months of therapy with nintedanib was assessed. RESULTS Forty-one patients with a forced vital capacity (FVC) ≤50% and/or a diffusing capacity of the lung for carbon monoxide (DLCO) ≤35% predicted at the start of nintedanib treatment were enrolled. At the 6-month follow-up, the decline of DLCO (both absolute and % predicted) was significantly reduced compared to the pretreatment period (absolute DLCO at the -6-month, T0, and +6-month time points (5.48, 4.50, and 5.03 mmol/min/kPa, respectively, p = 0.03; DLCO% predicted was 32.73, 26.54, and 29.23%, respectively, p = 0.04). No significant beneficial effect was observed in the other functional parameters analyzed. The 1-year survival in this population was 79%, calculated from month 6 of therapy with nintedanib. CONCLUSIONS This nationwide multicenter experience in patients with severe IPF shows that nintedanib slows down the rate of decline of absolute and % predicted DLCO but does not have significant impact on FVC or other lung parameters.
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Affiliation(s)
- Sergio Harari
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, IRCCS MultiMedica, Milan, Italy
| | - Antonella Caminati
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, IRCCS MultiMedica, Milan, Italy
| | - Venerino Poletti
- U.O. di Pneumologia, Dipartimento dell'Apparato Respiratorio e del Torace, Ospedale G.P. Morgagni-L. Pierantoni, Forlì, Italy
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Trieste, Trieste, Italy
| | - Stefano Gasparini
- Pulmonology Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Azienda Ospedaliera-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Fabrizio Luppi
- Center for Rare Lung Diseases, University Hospital Policlinico di Modena, Modena, Italy
| | - Alberto Pesci
- Respiratory Unit, Department of Health Science, University of Milano-Bicocca, AO San Gerardo, Monza, Italy
| | - Alfredo Sebastiani
- Department of Respiratory Diseases, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Paolo Spagnolo
- Section of Respiratory Disease, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Disease, University of Catania, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Elisabetta Balestro
- Section of Respiratory Disease, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Martina Bonifazi
- Pulmonology Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Azienda Ospedaliera-Universitaria "Ospedali Riuniti", Ancona, Italy
| | - Stefania Cerri
- Center for Rare Lung Diseases, University Hospital Policlinico di Modena, Modena, Italy
| | - Federica De Giacomi
- Respiratory Unit, Department of Health Science, University of Milano-Bicocca, AO San Gerardo, Monza, Italy
| | - Rossana Della Porta
- Department of Pulmonology, University Hospital of Cattinara, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" di Trieste, Trieste, Italy
| | | | - Annalisa Fui
- Respiratory Diseases and Lung Transplant Unit, Department of Internal and Specialist Medicine, AOUS, Siena, Italy
| | | | - Roberta Rosso
- Regional Referral Centre for Rare Lung Disease, University of Catania, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Sara Tomassetti
- U.O. di Pneumologia, Dipartimento dell'Apparato Respiratorio e del Torace, Ospedale G.P. Morgagni-L. Pierantoni, Forlì, Italy
| | - Claudia Specchia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,IRCCS MultiMedica, Milan, Italy
| | - Paola Rottoli
- Respiratory Diseases and Lung Transplant Unit, Department of Internal and Specialist Medicine, AOUS, Siena, Italy
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