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 Pulmonary Diseases and Tuberculosis Faculty of Medicine Masaryk University and University Hospital Brno 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

Rabin Medical Centre Petah Tikva Israel

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