Antifibrotic treatment improves clinical outcomes in patients with idiopathic pulmonary fibrosis: a propensity score matching analysis

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.

Diagnostic and prognostic implications of 2018 guideline for the diagnosis of idiopathic pulmonary fibrosis in clinical practice

“…In patients who underwent surgical lung biopsy, the diagnoses are based on combinations of HRCT and the surgical lung biopsy pattern followed by multidisciplinary discussion. The approximate rate of biopsy in patients with IPF in our center was about 30% between 2004 and 2017 as reported in a previously published study 25 . However, the rate of biopsies has changed over the long study inclusion period from 1995 to 2016, many patients with typical clinical and imaging features also underwent biopsies in the early period of the study inclusion.…”

Pirfenidone vs. nintedanib in patients with idiopathic pulmonary fibrosis: a retrospective cohort study

“…The HR became slightly lower in favor of pirfenidone, but the difference was not significant. Previous evidence already demonstrated the effectiveness of pirfenidone [ 8 , 12 , 31 ] and nintedanib [ 12 , 31 ] regarding reductions of respiratory-related and all-cause hospitalization. A direct comparison between both drugs in regard of all-cause hospitalization was so far only conducted by Corral et al [ 15 ].…”

Mortality and survival in idiopathic pulmonary fibrosis: a systematic review and meta-analysis

“…Similar trend was found for the 5-year CSRs (patients taking antifibrotics: 51.4% [95% CI, 44.1-58.7; I 2 = 97.9%] vs. those taking non-antifibrotics: 43.9% [95% CI, 39.9-47.8; I 2 =93.4%]) (P=0.084). In addition, there were no significant associations between various diagnostic criteria and CSRs, and those associations remained consistent after exclusion of 16 studies [27,32,39,40,43,49,50,52,55,66,68,71,74,85,86,88] in which patients received antifibrotics (Table 4).…”