Cause of mortality and sarcopenia in patients with idiopathic pulmonary fibrosis receiving antifibrotic therapy

Abstract

Background and objectiveRecent research has highlighted the fundamental role of sarcopenia, characterized by loss of skeletal muscle mass and strength, with a risk of poor outcomes. AFT preserves lung function by preventing the annual decline in FVC and is associated with improved outcomes in patients with IPF. However, altered cause of death and prognostic implications of sarcopenia in patients with IPF receiving AFT remain unknown.MethodsThis study comprised two cohorts of patients with IPF receiving AFT, historical cohort of IPF patients without AFT and controls. The cause of mortality was compared with a historical cohort. Sarcopenia was assessed by measuring the ESMCSA and ESMMA via CT.ResultsPatients with IPF had smaller ESMCSA and lower ESMMA but similar BMI than controls, suggesting patients with IPF had skeletal muscle loss without any obvious body weight loss. The most common cause of mortality in patients receiving AFT was chronic respiratory failure, accounting for approximately 60%, and decreased proportions of LC were found. Subsequently, low ESMCSA was an independent prognostic factor associated with worse survival rates. Furthermore, combined assessment of ESMCSA, %FVC predicted and BMI values provided clear prognostic distinction.ConclusionPatients with IPF receiving AFT showed skeletal muscle loss without obvious weight loss. These patients mostly died by chronic respiratory failure, and skeletal muscle wasting has prognostic significance, suggesting that preventing sarcopenia as well as preserving lung function are important for managing these patients.

Combined assessment of the GAP index and body mass index at antifibrotic therapy initiation for prognosis of idiopathic pulmonary fibrosis

“…In this setting, as the BMI was shown to have prognostic value independent of the GAP index and it is easy to measure, the present study examined the value of using GAP plus BMI in patients with IPF treated with AFT for prognostic separations. Recently, clinical implications of sarcopenia, a metabolic dysfunction involving loss of skeletal muscle, in ILD was reported beyond those in chronic obstructive pulmonary disease and cancer 17 – 19 . Indeed, skeletal-muscle loss was well correlated with lower BMI and was associated with worse outcome in patients with IPF 18 , 19 .…”

“…Recently, the clinical implication of sarcopenia, which is characterised by progressive and generalised skeletal disorder involving accelerated loss of muscle mass and function, has been highlighted in various diseases 14 , 15 . These metabolic dysfunctions, partly represented as muscle wasting and body-weight loss, are frequently found in patients with various respiratory-disease types, including ILD 16 – 19 . Importantly, muscle wasting and body-weight loss have been associated with poor outcome in patients with IPF 13 , 18 – 21 .…”

Switching antifibrotics in patients with idiopathic pulmonary fibrosis: a multi-center retrospective cohort study

“…Univariate and multivariate analyses were also performed using the Cox proportional hazards regression model. The variables of propensity score matching and multivariate Cox-regression analyses that were considered clinically important, and specific risk factors for mortality in IPF were selected [2,3,15,[18][19][20].…”

“…These two antifibrotics have distinct types of antifibrotic mechanisms [10] and different adverse drug reaction (ADR) profiles [11][12][13][14][15]. In the clinical setting, the choice of either pirfenidone or nintedanib is likely to be made partially in view of their profiles of ADRs.…”

Impact of Sarcopenia on Chemotherapy-Triggered Exacerbation of Interstitial Lung Disease in Patients With Non-Small Cell Lung Cancer

“…Sarcopenia is a syndrome characterized by progressive and systemic loss of skeletal muscle mass and strength 16 . Incidentally, recent reports have identi ed low skeletal muscle mass measured via computed tomography (CT) as a poor prognosis factor for lung cancer [17][18][19][20] and ILD [21][22][23][24][25] . Additionally, evidence has shown that sarcopenia was associated with chemotherapeutic dose-limiting toxicity and severe toxicity events in patients with various cancers 20,26,27 .…”