Therapeutic burden in interstitial lung disease: Lessons to learn

Abstract

Background and objective Patients with interstitial lung disease (ILD) are often prescribed disease‐targeted and symptomatic therapies, both of which can cause significant treatment burden due to polypharmacy and drug–disease interactions. This study aimed to evaluate medication regimen complexity before and after introduction of ILD‐specific therapies. Potential drug–disease interactions were evaluated for patients who were prescribed prednisolone. Methods In this study, 214 patients with ILD were assessed for demographic information, co‐morbidities and medication use. Medication lists were reviewed prior to and after the introduction of ILD‐specific therapies. Complexity of treatment regimen was examined using the validated Medication Regimen Complexity Index (MRCI). Results Of the 214 patients, 75 had idiopathic pulmonary fibrosis (IPF) while the rest had inflammatory ILD (chronic hypersensitivity pneumonitis: 45; connective tissue disease‐related ILD: 41). Polypharmacy was common at baseline (IPF: 51%, inflammatory ILD: 63%). Following introduction of ILD‐specific therapies, median total MRCI scores significantly increased from 8 (interquartile range (IQR) = 8–15) to 22.5 (17.5–27.5) and 14.5 (8.5–21) to 21.5 (16–30) for IPF and inflammatory ILD groups, respectively (P < 0.0001 for both). Complex dosing instructions contributed the most to total MRCI scores for ILD‐specific therapies. Among patients receiving prednisolone (n = 113), 88% had ≥1 co‐morbidity which may be impacted. Common co‐morbidities included gastrointestinal diseases (56%), obesity (37%), osteoporosis (24%) and diabetes mellitus (18%). Conclusion Polypharmacy and complex medication regimen are common in patients with ILD of different aetiologies. There is a high frequency of potential drug–disease interactions among patients who are prescribed systemic corticosteroids. These findings highlight the need for careful evaluation of the impact of therapeutic complexity and burden in patients with ILD.

Development and Validation of the Prognostic Index Based on Inflammation-Related Gene Analysis in Idiopathic Pulmonary Fibrosis

“…Regarding the changes in the understanding of inflammation, some researchers suggest that glucocorticoid treatment, a classic anti-inflammation therapy, is potentially effective in selected IPF patients (Heukels et al, 2019;Khor et al, 2019). Recent advances in precision treatment and increasing awareness of patient subgroup classification indicate a fundamental role of inflammation in IPF (Zhang et al, 2015).…”

The Effect of Pirfenidone on the Prescription of Antibiotics and Antitussive Drugs in Patients With Idiopathic Pulmonary Fibrosis

“…2 This polypharmacy results in complications related to the drug-drug interactions and increases in medical spending. 3 There is an urgent need to find ways to avoid polypharmacy in the management of IPF.Pirfenidone is an antifibrotic drug approved in multiple countries for the treatment of IPF. [4][5][6] In multinational phase III clinical trials, pirfenidone reduced disease progression as reflected by pulmonary function, exercise tolerance, and progression-free survival in patients with IPF.…”

“…2 This polypharmacy results in complications related to the drug-drug interactions and increases in medical spending. 3 There is an urgent need to find ways to avoid polypharmacy in the management of IPF.…”

Treatment of interstitial lung disease: Do the ends justify the means?

“…This background provides context to the analysis published in a recent publication in Respirology . Khor et al reviewed the medication list for 214 patients with interstitial lung disease (ILD), 75 of whom had IPF . The IPF patients, unsurprisingly, were nearly 70 years old on average, and all were on anti‐fibrotic therapy.…”

“…Dosing of corticosteroids, which is problematic clinically, especially in an ageing population, was noted to be associated with multiple comorbid conditions in patients with inflammatory ILD. When compared to other chronic diseases, the authors do note that the calculated MRCI for these ILD patients are comparable …”