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Raghu G, Ghazipura M, Fleming TR, Aronson KI, Behr J, Brown KK, Flaherty KR, Kazerooni EA, Maher TM, Richeldi L, Lasky JA, Swigris JJ, Busch R, Garrard L, Ahn DH, Li J, Puthawala K, Rodal G, Seymour S, Weir N, Danoff SK, Ettinger N, Goldin J, Glassberg MK, Kawano-Dourado L, Khalil N, Lancaster L, Lynch DA, Mageto Y, Noth I, Shore JE, Wijsenbeek M, Brown R, Grogan D, Ivey D, Golinska P, Karimi-Shah B, Martinez FJ. Meaningful Endpoints for Idiopathic Pulmonary Fibrosis (IPF) Clinical Trials: Emphasis on 'Feels, Functions, Survives'. Report of a Collaborative Discussion in a Symposium with Direct Engagement from Representatives of Patients, Investigators, the National Institutes of Health, a Patient Advocacy Organization, and a Regulatory Agency. Am J Respir Crit Care Med 2024; 209:647-669. [PMID: 38174955 DOI: 10.1164/rccm.202312-2213so] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/02/2024] [Indexed: 01/05/2024] Open
Abstract
Background: Idiopathic pulmonary fibrosis (IPF) carries significant mortality and unpredictable progression, with limited therapeutic options. Designing trials with patient-meaningful endpoints, enhancing the reliability and interpretability of results, and streamlining the regulatory approval process are of critical importance to advancing clinical care in IPF. Methods: A landmark in-person symposium in June 2023 assembled 43 participants from the US and internationally, including patients with IPF, investigators, and regulatory representatives, to discuss the immediate future of IPF clinical trial endpoints. Patient advocates were central to discussions, which evaluated endpoints according to regulatory standards and the FDA's 'feels, functions, survives' criteria. Results: Three themes emerged: 1) consensus on endpoints mirroring the lived experiences of patients with IPF; 2) consideration of replacing forced vital capacity (FVC) as the primary endpoint, potentially by composite endpoints that include 'feels, functions, survives' measures or FVC as components; 3) support for simplified, user-friendly patient-reported outcomes (PROs) as either components of primary composite endpoints or key secondary endpoints, supplemented by functional tests as secondary endpoints and novel biomarkers as supportive measures (FDA Guidance for Industry (Multiple Endpoints in Clinical Trials) available at: https://www.fda.gov/media/162416/download). Conclusions: This report, detailing the proceedings of this pivotal symposium, suggests a potential turning point in designing future IPF clinical trials more attuned to outcomes meaningful to patients, and documents the collective agreement across multidisciplinary stakeholders on the importance of anchoring IPF trial endpoints on real patient experiences-namely, how they feel, function, and survive. There is considerable optimism that clinical care in IPF will progress through trials focused on patient-centric insights, ultimately guiding transformative treatment strategies to enhance patients' quality of life and survival.
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Affiliation(s)
- Ganesh Raghu
- Center for Interstitial Lung Diseases, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine
- Department of Laboratory Medicine and Pathology, and
| | - Marya Ghazipura
- ZS Associates, Global Health Economics and Outcomes Research, New York, New York
- Division of Epidemiology and
- Division of Biostatistics, Department of Population Health, New York University Langone Health, New York, New York
| | - Thomas R Fleming
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Kerri I Aronson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Jürgen Behr
- Department of Medicine V, LMU University Hospital, Ludwig-Maximilians-University Munich, Member of the German Center for Lung Research, Munich, Germany
| | | | - Kevin R Flaherty
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ella A Kazerooni
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Health System, Detroit, Michigan
| | - Toby M Maher
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Luca Richeldi
- Divisione di Medicina Polmonare, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Joseph A Lasky
- Department of Medicine, Tulane University, New Orleans, Louisiana
| | | | - Robert Busch
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Lili Garrard
- Division of Biometrics III, Office of Biostatistics, Office of Translational Sciences, Center for Drug Evaluation and Research, and
| | - Dong-Hyun Ahn
- Division of Biometrics III, Office of Biostatistics, Office of Translational Sciences, Center for Drug Evaluation and Research, and
| | - Ji Li
- Division of Clinical Outcome Assessment, Office of Drug Evaluation Sciences, Office of New Drugs, and
| | - Khalid Puthawala
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Gabriela Rodal
- Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Sally Seymour
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Nargues Weir
- Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Sonye K Danoff
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Neil Ettinger
- Division of Pulmonary Medicine, St. Luke's Hospital, Chesterfield, Missouri
| | - Jonathan Goldin
- Department of Radiology, University of California, Los Angeles, Los Angeles, California
| | - Marilyn K Glassberg
- Department of Medicine, Stritch School of Medicine, Loyola Chicago, Chicago, Illinois
| | - Leticia Kawano-Dourado
- Hcor Research Institute - Hcor Hospital, São Paolo, Brazil
- Pulmonary Division, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil
| | - Nasreen Khalil
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Lancaster
- Division of Pulmonary, Critical Care, and Sleep Medicine, Vanderbilt University, Nashville, Tennessee
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, Colorado
| | - Yolanda Mageto
- Division of Pulmonary, Critical Care, and Sleep Medicine, Baylor University, Dallas, Texas
| | - Imre Noth
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, Virginia
| | | | - Marlies Wijsenbeek
- Centre of Interstitial Lung Diseases, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Robert Brown
- Patient representative and patient living with IPF, Lovettsville, Virginia
| | - Daniel Grogan
- Patient representative and patient living with IPF, Charlottesville, Virginia; and
| | - Dorothy Ivey
- Patient representative and patient living with IPF, Richmond, Virginia
| | - Patrycja Golinska
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Banu Karimi-Shah
- Division of Pulmonology, Allergy, and Critical Care, Office of Immunology and Inflammation, and
| | - Fernando J Martinez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
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