Statin Therapy and Outcomes in Trials of Nintedanib in Idiopathic Pulmonary Fibrosis

Kreuter, Michael; Costabel, Ulrich; Richeldi, Luca; Cottin, Vincent; Wijsenbeek, Marlies; Bonella, Francesco; Bendstrup, Elisabeth; Maher, Toby M.; Wachtlin, Daniel; Stowasser, Susanne; Kolb, Martin

doi:10.1159/000486286

Cited by 47 publications

(29 citation statements)

References 28 publications

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“…A further post-hoc analysis examined the impact of statin use on the efficacy of nintedanib in the INPULSIS trials. 23 The treatment effect of nintedanib was consistent between patients receiving and not receiving statins.…”

Section: Nintedanib: Efficacy Evidencementioning

confidence: 87%

Nintedanib in the management of idiopathic pulmonary fibrosis: clinical trial evidence and real-world experience

Ortega

Hayton

Blaikley

et al. 2018

Ther Adv Respir Dis

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Idiopathic pulmonary fibrosis (IPF) is a fibrotic interstitial lung disease associated with significant morbidity and mortality. Previously, IPF has been managed using immunosuppressive therapy; however, it has been shown that this is associated with increased mortality. In the last 5 years, two disease-modifying agents have been licensed for use in IPF, namely pirfenidone and nintedanib. Nintedanib is a tyrosine kinase inhibitor with antifibrotic properties that has also been shown to significantly reduce the progression of the disease. The scientific evidence shows that nintedanib is effective and well tolerated for the treatment of IPF in mild, moderate and severe stages of the disease. Real-world experiences also support the findings of previously conducted clinical trials and show that nintedanib is effective for the management of IPF and is associated with reducing disease progression. Gastrointestinal events, mainly diarrhoea, are the main adverse events caused by the treatment. Recent real-word studies also suggest that nintedanib stabilizes lung function till lung transplantation, with no increased surgical complications or postoperative mortality after lung transplantation. In this review, we will discuss the clinical trial evidence and real-world experience for nintedanib in the management of IPF.

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Section: Nintedanib: Efficacy Evidencementioning

confidence: 87%

Nintedanib in the management of idiopathic pulmonary fibrosis: clinical trial evidence and real-world experience

Ortega

Hayton

Blaikley

et al. 2018

Ther Adv Respir Dis

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“…In addition to their anti-in ammatory actions, our recent investigation showed that statins inhibit tissue damage by reducing extracellular matrix synthesis in airway mesenchymal cells [77,78]. Several studies have shown bene cial effects of statins in the treatment and recovery of patients with idiopathic pulmonary brosis and implied that statins improve lung function by acting on brosis mediators [79,80]. In addition, statins reduce mortality in these patients and those with interstitial lung disease [81].…”

Section: Discussionmentioning

confidence: 99%

Statins in Patients with COVID-19: A Retrospective Cohort Study in Iranian COVID-19 Patients

Peymani

Dehesh

Aligolighasemabadi

et al. 2020

Preprint

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Background: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has profoundly affected the lives of millions of people. To date, there is no approved vaccine or specific drug to prevent or treat COVID-19, while the infection is spreading at an alarming rate globally. Because the development of effective vaccines or novel drugs could take several months (if not years), repurposing existing drugs is considered a more efficient strategy that could save lives now. Statins constitute a class of lipid-lowering drugs with proven safety profiles and many known beneficial pleiotropic effects. Our previous investigations showed that statins have antiviral effects and are involved in the process of wound healing in the lung. This triggered us to evaluate if statin use reduces mortality in COVID-19 patients. Results: After initial recruitment of 459 patients with COVID-19 (Shiraz province, Iran) and careful consideration of the exclusion criteria, a total of 150 patients, of which 75 received statins, were included in our retrospective study. Cox proportional-hazards regression models were used to estimate the association between statin use and rate of death. After propensity score matching, we found that statin use appeared to be associated with a lower risk of morbidity [HR=0.85, 95% CI=(0.02, 3.93), P=0.762] and lower risk of death [(HR= 0.76; 95% CI=(0.16, 3.72), P=0.735)]; however, these associations did not reach statistical significance. Furthermore, statin use reduced the chance of being subjected to mechanical ventilation [OR=0.96, 95% CI=(0.61–2.99), P=0.942] and patients on statins had a more normal computed tomography (CT) scan result [OR=0.41, 95% CI= (0.07–2.33), P=0.312]. Conclusions: Although we could not demonstrate a significant association between statin use and a reduction in mortality in patients with COVID19 , we do feel that our results are promising and of clinical relevance and warrant the need for prospective randomized controlled trials and extensive retrospective studies to validate the potential beneficial effects of statin treatment on clinical symptoms and mortality rates associated with COVID-19.

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“…Statins and anti-acid treatment were proposed to reduce incidence of AE-IPF, with prospective studies needed to confirm this hypothesis [ 14 , 54 ].…”

Section: Complicationsmentioning

confidence: 99%

Comorbidities, Complications and Non-Pharmacologic Treatment in Idiopathic Pulmonary Fibrosis

et al. 2018

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Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive and fatal disease. The treatment is challenging and nowadays a comprehensive approach based not only in pharmacological strategies is necessary. Identification and control of comorbidities, non-pharmacological treatment, prevention and management of exacerbations as well as other areas of care (social, psychological) are fundamental for a holistic management of IPF. Gastroesophageal reflux, pulmonary hypertension, obstructive sleep apnea, combined with emphysema, lung cancer and cardiovascular involvement are the main comorbidities associated with IPF. Non-pharmacological treatment includes the use of oxygen in patients with rest or nocturnal hypoxemia and other support therapies such as non-invasive ventilation or even a high-flow nasal cannula to improve dyspnea. In some patients, lung transplant should be considered as this enhances survival. Pulmonary rehabilitation can add benefits in outcomes such control of dyspnea, exercise capacity distance and, overall, improve the quality of life; therefore it should be considered in patients with IPF. Also, multidisciplinary palliative care programs could help with symptom control and psychological support, with the aim of maintaining quality of life during the whole process of the disease. This review intends to provide clear information to help those involved in IPF follow up to improve patients’ daily care.

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Statin Therapy and Outcomes in Trials of Nintedanib in Idiopathic Pulmonary Fibrosis

Cited by 47 publications

References 28 publications

Nintedanib in the management of idiopathic pulmonary fibrosis: clinical trial evidence and real-world experience

Nintedanib in the management of idiopathic pulmonary fibrosis: clinical trial evidence and real-world experience

Statins in Patients with COVID-19: A Retrospective Cohort Study in Iranian COVID-19 Patients

Comorbidities, Complications and Non-Pharmacologic Treatment in Idiopathic Pulmonary Fibrosis

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