Boehringer Ingelheim Pharmaceuticals, Inc., 900 Ridgebury Rd, Ridgefield, CT, 06877, USA.
BMC Pulm Med. 2022 Apr 23;22(1):153. doi: 10.1186/s12890-022-01953-9.
Interstitial lung diseases (ILDs) include a variety of parenchymal lung diseases. The most common types of ILDs are idiopathic pulmonary fibrosis (IPF), autoimmune ILDs and hypersensitivity pneumonitis (HP). There is limited real world data on care patterns of patients with chronic fibrosing ILDs with a progressive phenotype other than IPF. Therefore, the aim of this study is to describe care patterns in these patients.
This retrospective cohort study used claims data from 2015 to 2019 from the Optum Research Database. The study population included adults (≥ 18 years old) with at least two diagnosis codes for fibrosing ILD during the identification period (1OCT2016 to 31DEC2018). A claim-based algorithm for disease progression was used to identify patients likely to have a progressive fibrotic phenotype using progression proxies during the identification period. Index date was the first day of progression proxy identification after fibrosing ILD diagnosis. Patients were required to have continuous enrollment for 12 months before (baseline) and after (follow-up) index date. Patients with an IPF diagnosis were excluded. Descriptive statistics were used to describe the patient population and care patterns.
11,204 patients were included in the study. Mean age of the patient population was 72.7 years, and 54.5% were female. Unclassified ILDs (48.0%), HP (25.2%) and autoimmune ILDs (16.0%) were the most common ILD types. Other respiratory conditions were prevalent among patients including chronic obstructive pulmonary disease (COPD) (58.9%), obstructive sleep apnea (OSA) (25.0%) and pulmonary hypertension (9.8%). During baseline, 65.3% of all patients had at least one pulmonology visit, this proportion was higher during follow-up, at 70.6%. Baseline and follow-up use for HRCT were 39.9% and 48.8%, and for pulmonary function tests were 43.7% and 48.5% respectively. Use of adrenal corticosteroids was higher during follow-up than during baseline (62.5% vs. 58.0%). Anti-inflammatory and immunosuppressive medication classes were filled by a higher percentage of patients during follow-up than during baseline.
Comprehensive testing is essential for diagnosis of a progressive phenotype condition, but diagnostic tests were underutilized. Patients with this condition frequently were prescribed anti-inflammatory and immunosuppressive medications.
间质性肺疾病（ILDs）包括多种实质肺疾病。ILDs 最常见的类型是特发性肺纤维化（IPF）、自身免疫性ILDs 和过敏性肺炎（HP）。目前，对于除 IPF 以外的具有进行性表型的慢性纤维性 ILD 患者的护理模式，仅有有限的真实世界数据。因此，本研究旨在描述这些患者的护理模式。
本回顾性队列研究使用了 2015 年至 2019 年来自 Optum Research Database 的索赔数据。研究人群包括在识别期（2016 年 10 月 1 日至 2018 年 12 月 31 日）至少有两次纤维性 ILD 诊断代码的成年人（≥18 岁）。使用疾病进展代理的基于索赔的算法来识别在识别期内可能具有进行性纤维化表型的患者。索引日期是在纤维性 ILD 诊断后确定进展代理识别的第一天。患者需要在索引日期之前（基线）和之后（随访）连续登记 12 个月。排除 IPF 诊断的患者。使用描述性统计来描述患者人群和护理模式。
研究纳入了 11204 名患者。患者人群的平均年龄为 72.7 岁，54.5%为女性。未分类的 ILD（48.0%）、HP（25.2%）和自身免疫性 ILD（16.0%）是最常见的 ILD 类型。其他呼吸系统疾病在患者中很常见，包括慢性阻塞性肺疾病（COPD）（58.9%）、阻塞性睡眠呼吸暂停（OSA）（25.0%）和肺动脉高压（9.8%）。在基线时，所有患者中有 65.3%至少有一次肺病就诊，随访时这一比例更高，为 70.6%。基线和随访时 HRCT 的使用率分别为 39.9%和 48.8%，肺功能检查的使用率分别为 43.7%和 48.5%。在随访期间，使用肾上腺皮质激素的比例高于基线（62.5%比 58.0%）。在随访期间，使用抗炎和免疫抑制药物的患者比例高于基线。
全面的检测对于诊断进行性表型疾病至关重要，但诊断性检测的使用率较低。患有这种疾病的患者经常被开具抗炎和免疫抑制药物。
