Physician characteristics associated with treatment initiation patterns in idiopathic pulmonary fibrosis

Abstract

Pirfenidone and nintedanib are oral antifibrotic agents approved for the treatment of idiopathic pulmonary fibrosis (IPF). Real-world data on factors that influence IPF treatment decisions are limited. Physician characteristics associated with antifibrotic therapy initiation following an IPF diagnosis were examined in a sample of US pulmonologists. An online, self-administered survey was fielded to pulmonologists between April 10, 2017, and May 17, 2017. Pulmonologists were included if they spent >20% of their time in direct patient care and had ≥5 patients with IPF receiving antifibrotics. Participants answered questions regarding timing and reasons for considering the initiation of antifibrotic therapy after an IPF diagnosis. A total of 169 pulmonologists participated. The majority (81.7%) considered initiating antifibrotic therapy immediately after IPF diagnosis all or most of the time (immediate group), while 18.3% considered it only some of the time or not at all (delayed group). Pulmonologists in the immediate group were more likely to work in private practice (26.1%), have a greater mean percentage of patients receiving antifibrotic therapy (60.8%), and decide to initiate treatment themselves (31.2%) versus those in the delayed group (16.1%, 30.5%, and 16.1%, respectively). Most pulmonologists consider initiating antifibrotic treatment immediately after establishing an IPF diagnosis all or most of the time versus using a “watch-and-wait” approach. Distinguishing characteristics between pulmonologists in the immediate group versus the delayed group included practice setting, percentage of patients receiving antifibrotic therapy, and the decision-making dynamics between the patient and the pulmonologist.

Therapeutic decisions in a cohort of patients with idiopathic pulmonary fibrosis: a multicenter, prospective survey from Poland

“… 31 , 33 , 34 The list of factors delaying early initiation of treatment includes a ‘wait-and-watch’ strategy, treatment risk–benefit ratio considerations, limited physician experience with IPF patient management, and local drug reimbursement regulations. 31 , 35 In the setting of treatment within the frame of the Polish NHF therapeutic program, the relatively long time interval between diagnosis and treatment may also be attributed to formal issues associated with inclusion to the program. This includes the qualification process, registration to the program, waiting list for a visit in an authorized pulmonology center, and, finally, waiting for the arrival of the prescribed medication to the dedicated pulmonology center.…”

Idiopathic pulmonary fibrosis: Physician and patient perspectives on the pathway to care from symptom recognition to diagnosis and disease burden

“…Low antifibrotic use in Japan may be associated with high rates of gastrointestinal side effects in this population 27 and delays in patient financial support. Although most pulmonologists considered initiating antifibrotic therapy immediately after IPF diagnosis (81.7% in a recent US study), 28 the proportion of patients receiving therapy is often substantially smaller 29 . Pulmonologists who saw fewer patients with IPF were less comfortable discussing a patient's prognosis, believed less in the effectiveness of antifibrotic therapy, tended to adopt a ‘watch and wait approach’ and were more likely to wait >4 months between diagnosis and treatment initiation 30 .…”