Department of Respiratory Medicine, Public Tomioka General Hospital, 2073-1, Tomioka, Tomioka, Gunma 370-2393, Japan; Department of Respiratory Medicine, Kiryu Kosei General Hospital, 6-3, Orihime-machi, Kiryu, Gunma 376-0024, Japan.
Department of Respiratory Medicine, Gunma University Graduate School of Medicine, 3-39-15, Showa-machi, Maebashi, Gunma 371-8511, Japan.
Respir Investig. 2024 May;62(3):388-394. doi: 10.1016/j.resinv.2024.02.012. Epub 2024 Mar 8.
The antifibrotic agents pirfenidone and nintedanib have been shown to be effective in patients with idiopathic pulmonary fibrosis (IPF). However, discontinuation of antifibrotic drugs is a major clinical concern because of the lack of alternative treatment options. Therefore, we identified factors that may be useful for predicting the termination of antifibrotic agents.
We retrospectively recruited 280 IPF patients treated with antifibrotic drugs between 2009 and 2018 from seven regional core hospitals in Gunma prefecture, Japan.
At four months, the short-term discontinuation group exhibited a significantly worse prognosis in the pirfenidone group and a poorer prognosis in the nintedanib group compared to that in the continuation group. The discontinuation group of pirfenidone at 4 months exhibited lower albumin and higher C-reactive protein (CRP) levels in the sera compared to the group that continued treatment for more than 4 months. In multivariate analysis, the Glasgow prognostic score (GPS), well known as a predictor of cancer prognosis, which comprises serum CRP and albumin levels, predicted early discontinuation and prognosis in the pirfenidone group, whereas the body mass index (BMI) predicted early discontinuation of nintedanib. A high GPS, with both albumin <3.5 g/dL and CRP >1.0 mg/dL, was associated with a poorer prognosis in the pirfenidone group.
GPS and BMI were significant factors for short-term pirfenidone and nintedanib discontinuation, respectively. Initial evaluation of GPS and BMI prior to antifibrotic therapy may contribute to less interrupted IPF management, thus leading to better prognostic outcomes in patients with IPF.
吡非尼酮和尼达尼布这两种抗纤维化药物已被证明对特发性肺纤维化（IPF）患者有效。然而，由于缺乏替代治疗方案，抗纤维化药物的停药是一个主要的临床关注点。因此，我们确定了可能有助于预测抗纤维化药物停药的因素。
我们回顾性招募了 2009 年至 2018 年期间来自日本群马县 7 家区域核心医院接受抗纤维化药物治疗的 280 名 IPF 患者。
在 4 个月时，与继续治疗组相比，短期停药组在吡非尼酮组中预后明显较差，在尼达尼布组中预后更差。与继续治疗 4 个月以上的患者相比，4 个月时吡非尼酮停药组的血清白蛋白水平较低，C 反应蛋白（CRP）水平较高。多变量分析显示，格拉斯哥预后评分（GPS）是一种预测癌症预后的指标，由血清 CRP 和白蛋白水平组成，可预测吡非尼酮组的早期停药和预后，而体重指数（BMI）则预测尼达尼布的早期停药。高 GPS（白蛋白<3.5g/dL 和 CRP>1.0mg/dL）与吡非尼酮组的预后较差相关。
GPS 和 BMI 分别是吡非尼酮和尼达尼布短期停药的重要因素。在开始抗纤维化治疗之前，对 GPS 和 BMI 进行初始评估可能有助于减少 IPF 管理中断，从而改善 IPF 患者的预后。
