Outcomes for hospitalized patients with idiopathic pulmonary fibrosis treated with antifibrotic medications

BMC Pulmonary Medicine

Taylor T. Teague¹  Bryan T. Kelly¹  Timothy M. Dempsey¹  Teng Moua¹  Andrew H. Limper²  Nilay D. Shah³  Viengneesee Thao⁴  Lindsey R. Sangaralingham⁴  Stephanie R. Payne⁴ 

[1] Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Gonda 18-South, 200 1st St SW, 55905, Rochester, MN, USA;Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Gonda 18-South, 200 1st St SW, 55905, Rochester, MN, USA;Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA;Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA;Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA;Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA;OptumLabs, Cambridge, MA, USA;

关键词: Idiopathic pulmonary fibrosis;    Antifibrotics;    Hospitalization;    Critical care;    Mechanical ventilation;   

DOI  :  10.1186/s12890-021-01607-2

来源: Springer

【 摘 要 】

BackgroundIdiopathic Pulmonary Fibrosis is a chronic, progressive interstitial lung disease for which there is no cure. However, lung function decline, hospitalizations, and mortality may be reduced with the use of the antifibrotic medications, nintedanib and pirfenidone. Historical outcomes for hospitalized patients with Idiopathic Pulmonary Fibrosis are grim; however there is a paucity of data since the approval of nintedanib and pirfenidone for treatment. In this study, we aimed to determine the effect of nintedanib and pirfenidone on mortality following respiratory-related hospitalizations, intensive care unit (ICU) admission, and mechanical ventilation.MethodsUsing a large U.S. insurance database, we created a one-to-one propensity score matched cohort of patients with idiopathic pulmonary fibrosis treated and untreated with an antifibrotic who underwent respiratory-related hospitalization between January 1, 2015 and December 31, 2018. Mortality was evaluated at 30 days and end of follow-up (up to 2 years). Subgroup analyses were performed for all patients receiving treatment in an ICU and those receiving invasive and non-invasive mechanical ventilation during the index hospitalization.ResultsAntifibrotics were not observed to effect utilization of mechanical ventilation or ICU treatment during the index admission or effect mortality at 30-days. If patients survived hospitalization, mortality was reduced in the treated cohort compared to the untreated cohort when followed up to two years (20.1% vs 47.8%).ConclusionsTreatment with antifibrotic medications does not appear to directly improve 30-day mortality during or after respiratory-related hospitalizations. Post-hospital discharge, however, ongoing antifibrotic treatment was associated with improved long-term survival.

【 授权许可】

CC BY