Okamoto Masaki, Yanagihara Toyoshi, Fujimoto Kiminori, Chikasue Tomonori, Tabata Kazuhiro, Zaizen Yoshiaki, Tominaga Masaki, Sumi Akiko, Nishii Yuuya, Matsuo Norikazu, Nouno Takashi, Matsuura Shuji, Kawaguchi Atsushi, Hoshino Tomoaki
Department of Respirology, NHO Kyushu Medical Center, Jigyohama 1-8-1, Chuo-ku, Fukuoka 810-0065, Japan.
Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Asahi-Machi 67, Kurume 830-0011, Japan.
J Clin Med. 2024 Dec 23;13(24):7865. doi: 10.3390/jcm13247865.
The degree of exercise-induced oxygen desaturation and outcomes following antifibrotic drug therapy in asymptomatic patients with fibrosing interstitial lung disease (FILD) remain unclear. We compared clinical data, incidence of annual FILD progression, overall survival, and tolerability after initiating nintedanib between 58 patients with dyspnea and 18 patients without. Annual FILD progression was defined as >10% decrease in forced vital capacity (FVC), >15% decrease in diffusing capacity of the lungs for carbon monoxide (D), developing acute exacerbations, or FILD-related death within 1 year of starting nintedanib. Outcomes between the two groups were adjusted for covariates, including age, gender, FVC, D, and diagnosis of idiopathic pulmonary fibrosis, all known prognostic factors for FILD. In 6-min walk test, incidence of decrease to <90% of SpO was significantly lower in non-dyspnea group than in dyspnea group (24% vs. 55%, = 0.028), but incidence of >4% decreases showed no significant difference (71% vs. 89%, = 0.11) The incidence of annual progression was significantly lower in non-dyspnea than in dyspnea group (17% vs. 53%, adjusted = 0.026). The relative change in D was significantly slower in non-dyspnea group (adjusted = 0.036), but FVC was not (adjusted = 0.067). Overall survival was longer in non-dyspnea group (adjusted = 0.0089). The discontinuation rate and therapeutic period of nintedanib were not significantly different between the groups. Asymptomatic patients with FILD have severe exercise-induced oxygen desaturation and better outcomes after nintedanib therapy than symptomatic patients. Antifibrotic drug therapy should not be avoided solely because of a lack of symptoms.
在无症状的纤维化间质性肺疾病（FILD）患者中，运动诱发的氧饱和度下降程度以及抗纤维化药物治疗后的结局仍不明确。我们比较了58例有呼吸困难的患者和18例无呼吸困难的患者在开始使用尼达尼布后的临床数据、年度FILD进展发生率、总生存率和耐受性。年度FILD进展定义为在开始使用尼达尼布后1年内，用力肺活量（FVC）下降>10%、肺一氧化碳弥散量（D）下降>15%、发生急性加重或FILD相关死亡。对两组的结局进行协变量调整，包括年龄、性别、FVC、D以及特发性肺纤维化的诊断，所有这些都是FILD已知的预后因素。在6分钟步行试验中，非呼吸困难组SpO₂降至<90%的发生率显著低于呼吸困难组（24%对55%，P = 0.028），但下降>4%的发生率无显著差异（71%对89%，P = 0.11）。非呼吸困难组的年度进展发生率显著低于呼吸困难组（17%对53%，调整后P = 0.026）。非呼吸困难组D的相对变化明显较慢（调整后P = 0.036），但FVC并非如此（调整后P = 0.067）。非呼吸困难组的总生存期更长（调整后P = 0.0089）。两组间尼达尼布的停药率和治疗期无显著差异。无症状的FILD患者运动诱发的氧饱和度下降严重，尼达尼布治疗后的结局比有症状的患者更好。不应仅因无症状而避免使用抗纤维化药物治疗。
