The Impact of Switching to a Second Antifibrotic in Patients With Idiopathic Pulmonary Fibrosis: A Retrospective Multicentre Study From the EMPIRE Registry
Language English, Spanish Country Spain Media print-electronic
Document type Multicenter Study, Journal Article
PubMed
38160169
DOI
10.1016/j.arbres.2023.12.002
PII: S0300-2896(23)00403-9
Knihovny.cz E-resources
- Keywords
- Antifibrotic agents, Registries, Survival, Treatment switch,
- MeSH
- Antifibrotic Agents * therapeutic use MeSH
- Idiopathic Pulmonary Fibrosis * drug therapy mortality MeSH
- Indoles MeSH
- Middle Aged MeSH
- Humans MeSH
- Drug Substitution * MeSH
- Disease Progression MeSH
- Pyridones therapeutic use MeSH
- Registries * MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Vital Capacity MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Names of Substances
- Antifibrotic Agents * MeSH
- Indoles MeSH
- nintedanib MeSH Browser
- pirfenidone MeSH Browser
- Pyridones MeSH
INTRODUCTION: Most patients with idiopathic pulmonary fibrosis (IPF) treated with antifibrotics (AF) have progressive disease despite treatment. A switch of AF may improve survival, but evidence from randomised controlled trials is missing. We aimed to evaluate the efficacy of an AF switch on survival and FVC decline in patients from the European MultiPartner IPF registry (EMPIRE). METHODS: The study included 612 patients who discontinued the first antifibrotic therapy. Patients were grouped and analysed from two perspectives: (1) whether they had received a second antifibrotic treatment after the discontinuation of the first therapy, and (2) a reason for discontinuation of the first AF - "lack of efficacy" (LE) and "intolerance" (INT). RESULTS: While 263 (43%) of 612 patients received no second AF ("non-switched"), 349 (57%) patients switched. Overall survival was higher in patients who received a second AF (median 50 vs. 29 months; adjusted HR 0.64, P=0.023). Similarly, the annual FVC decline was significantly reduced in switched patients: -98ml/y in switched and -172ml/y in non-switched patients (P=0.023), respectively. The switched patients had similar risk for mortality in both LE and INT groups (adjusted HR 0.95, P=0.85). The high impact of switching on survival was demonstrated in LE patients (adjusted HR 0.27, P<0.001). CONCLUSION: The patients without a second AF had significantly shorter overall survival. Our analysis suggests the importance of switching patients with an ineffective first AF therapy to a second AF therapy.
1st Department of Pulmonary Diseases Institute of Tuberculosis and Lung Diseases Warsaw Poland
Carmel Medical Center Haifa Israel
Department of Chest Diseases Faculty of Medicine Ege University Izmir Turkey
Department of Pneumology and Thoracic Surgery Hospital Na Bulovce Prague Czech Republic
Department of Pneumology University Hospital Hradec Králové Czech Republic
Department of Pneumology University Hospital Ostrava Czech Republic
Department of Pulmonology Faculty of Medicine Semmelweis University Budapest Hungary
Department of Respiratory Medicine Paracelsus Medical University Salzburg Austria
Department of Respiratory Medicine Thomayer University Hospital Prague Czech Republic
Department of Respiratory Medicine University Hospital Olomouc Czech Republic
Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic
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