Eaden James A, Barber Christopher M, Renshaw Stephen A, Chaudhuri Nazia, Bianchi Stephen M
Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.
Respiratory Medicine Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
Sarcoidosis Vasc Diffuse Lung Dis. 2020;37(2):218-224. doi: 10.36141/svdld.v37i2.8587. Epub 2020 Jun 30.
Pirfenidone has been shown to reduce the decline in forced vital capacity (FVC) compared to placebo in patients with idiopathic pulmonary fibrosis (IPF). Previous studies have suggested that patients with a more rapid decline in FVC during the period before starting pirfenidone experience the greatest benefit from treatment. The purpose of this retrospective observational study was to investigate the response to pirfenidone in IPF patients, comparing two groups stratified by the annual rate of decline in FVC % predicted prior to treatment.
Using the rate of decline in FVC % predicted in the 12 months prior to pirfenidone, patients were stratified into slow (<5%) or rapid (≥5%) decliner groups. Comparisons in the lung function response to pirfenidone in these two groups were performed.
Pirfenidone resulted in no statistically significant reduction in the median annual rate of decline in FVC or FVC % predicted. In the rapid decliners, pirfenidone significantly reduced the median (IQR) annual rate of decline in FVC % predicted (-8.7 (-14.2 - -7.0) %/yr vs 2.0 (-7.1 - 6.0) %/yr; n=17; p<0.01). In the slow decliners, pirfenidone did not reduce the median (IQR) annual rate of decline in FVC % predicted (-1.3 (-3.2 - 1.3) %/yr vs -5.0 (-8.3 - -0.35) %/yr; n=17; p=0.028).
We demonstrate the greater net effect of pirfenidone in IPF patients declining rapidly. We suggest that using an annual rate of decline in FVC of <5% and ≥5% may be useful in counselling patients with regard to pirfenidone treatment. .
与安慰剂相比，吡非尼酮已被证明可减少特发性肺纤维化（IPF）患者的用力肺活量（FVC）下降。先前的研究表明，在开始使用吡非尼酮治疗前FVC下降较快的患者从治疗中获益最大。这项回顾性观察研究的目的是调查IPF患者对吡非尼酮的反应，比较根据治疗前预测的FVC下降年率分层的两组患者。
根据吡非尼酮治疗前12个月预测的FVC下降率，将患者分为下降缓慢组（<5%）或下降快速组（≥5%）。对这两组患者使用吡非尼酮后的肺功能反应进行比较。
吡非尼酮并未使FVC年下降率中位数或预测的FVC%出现统计学上的显著降低。在下降快速组中，吡非尼酮显著降低了预测的FVC%年下降率中位数（IQR）（-8.7（-14.2至-7.0）%/年 vs 2.0（-7.1至6.0）%/年；n = 17；p<0.01）。在下降缓慢组中，吡非尼酮并未降低预测的FVC%年下降率中位数（IQR）（-1.3（-3.2至1.3）%/年 vs -5.0（-8.3至-0.35）%/年；n = 17；p = 0.028）。
我们证明了吡非尼酮对FVC快速下降的IPF患者有更大的净效应。我们建议，使用FVC年下降率<5%和≥5%这一标准，可能有助于向患者提供有关吡非尼酮治疗的咨询。
