Department of Respiratory Medicine, Herlev and Gentofte Hospital, Hellerup, Denmark.
Department of Respiratory Medicine, Herlev and Gentofte Hospital, Hellerup, Denmark.
Respir Med. 2022 Nov-Dec;204:107015. doi: 10.1016/j.rmed.2022.107015. Epub 2022 Oct 25.
Idiopathic pulmonary fibrosis (IPF) is a severe interstitial lung disease for which two effective antifibrotics, nintedanib and pirfenidone, are available. However, many patients receive a reduced dosage or pause treatment due to side effects although the impact of antifibrotic treatment reduction is uncertain.
We retrospectively investigated the impact of antifibrotic treatment reduction on death in a large real-life IPF cohort. The primary endpoint of the analyses was time until death by any cause. Five patient groups were defined based on treatment intensity (full, reduced or no treatment) and the antifibrotic drug type (pirfenidone or nintedanib). Between group survival was compared using Cox proportional hazards analysis adjusted for age, sex, smoking status, and lung function at baseline.
375 patients from the Danish PFBIO-cohort were followed from April 2016 until November 2021 with a median follow-up time of 1.84 years. Of patients receiving nintedanib and pirfenidone, 80.19% and 67.42% had reduced treatment, respectively, when considering the entire follow-up period. Treatment with nintedanib and pirfenidone was associated with improved survival compared to no antifibrotic treatment independent of treatment intensity (nintedanib: HR: 0.31, 95%-CI: 0.19-0.53, p < 0.001 & pirfenidone: HR: 0.26, 95%-CI: 0.16-0.42, p < 0.001). Nintedanib and pirfenidone in lower intensities were not associated with worse survival outcomes.
A substantial proportion of patients with IPF receive reduced antifibrotic treatment to ameliorate the side effects associated with a full dosage regime. Treatment with nintedanib and pirfenidone, independent of treatment intensity, was preferable over no antifibrotic treatment in improving survival and reduced dose appears to be a good alternative if full dose is not tolerated.
特发性肺纤维化（IPF）是一种严重的间质性肺疾病，目前有两种有效的抗纤维化药物，尼达尼布和吡非尼酮可用。然而，许多患者因副作用而接受减少剂量或暂停治疗，尽管抗纤维化治疗减少的影响尚不确定。
我们回顾性调查了在一个大型真实 IPF 队列中抗纤维化治疗减少对死亡的影响。分析的主要终点是任何原因导致的死亡时间。根据治疗强度（全剂量、减少剂量或无治疗）和抗纤维化药物类型（吡非尼酮或尼达尼布），将患者分为五组。使用 Cox 比例风险分析比较组间生存情况，调整年龄、性别、吸烟状况和基线时的肺功能。
375 名来自丹麦 PFBIO 队列的患者从 2016 年 4 月至 2021 年 11 月进行随访，中位随访时间为 1.84 年。考虑整个随访期间，接受尼达尼布和吡非尼酮治疗的患者中，分别有 80.19%和 67.42%减少了治疗。与无抗纤维化治疗相比，无论治疗强度如何，尼达尼布和吡非尼酮治疗均与生存改善相关（尼达尼布：HR：0.31，95%CI：0.19-0.53，p < 0.001；吡非尼酮：HR：0.26，95%CI：0.16-0.42，p < 0.001）。较低强度的尼达尼布和吡非尼酮与生存结果恶化无关。
相当一部分 IPF 患者接受减少剂量的抗纤维化治疗以减轻全剂量治疗相关的副作用。尼达尼布和吡非尼酮治疗，无论治疗强度如何，均优于无抗纤维化治疗，可改善生存，且如果不能耐受全剂量，减少剂量似乎是一个不错的替代选择。
