Outcomes for hospitalized patients with idiopathic pulmonary fibrosis treated with antifibrotic medications

Autor: Andrew H. Limper, Stephanie Payne, Lindsey R. Sangaralingham, Bryan T. Kelly, Viengneesee Thao, Timothy M. Dempsey, Nilay Shah, Teng Moua, T. Teague
Rok vydání: 2021
Předmět:
Male
Indoles
medicine.medical_treatment
law.invention
Cohort Studies
Idiopathic pulmonary fibrosis
chemistry.chemical_compound
Mechanical ventilation
0302 clinical medicine
law
Cause of Death
030212 general & internal medicine
Aged
80 and over
Anti-Inflammatory Agents
Non-Steroidal
Interstitial lung disease
Pirfenidone
Middle Aged
Intensive care unit
Hospitalization
Treatment Outcome
Cohort
Female
Nintedanib
medicine.drug
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Antifibrotics
Pyridones
Diseases of the respiratory system
03 medical and health sciences
Internal medicine
medicine
Humans
Mortality
Propensity Score
Protein Kinase Inhibitors
Aged
RC705-779
business.industry
Research
medicine.disease
United States
Critical care
Logistic Models
030228 respiratory system
chemistry
Propensity score matching
business
Zdroj: BMC Pulmonary Medicine, Vol 21, Iss 1, Pp 1-14 (2021)
BMC Pulmonary Medicine
ISSN: 1471-2466
Popis: Background Idiopathic Pulmonary Fibrosis is a chronic, progressive interstitial lung disease for which there is no cure. However, lung function decline, hospitalizations, and mortality may be reduced with the use of the antifibrotic medications, nintedanib and pirfenidone. Historical outcomes for hospitalized patients with Idiopathic Pulmonary Fibrosis are grim; however there is a paucity of data since the approval of nintedanib and pirfenidone for treatment. In this study, we aimed to determine the effect of nintedanib and pirfenidone on mortality following respiratory-related hospitalizations, intensive care unit (ICU) admission, and mechanical ventilation. Methods Using a large U.S. insurance database, we created a one-to-one propensity score matched cohort of patients with idiopathic pulmonary fibrosis treated and untreated with an antifibrotic who underwent respiratory-related hospitalization between January 1, 2015 and December 31, 2018. Mortality was evaluated at 30 days and end of follow-up (up to 2 years). Subgroup analyses were performed for all patients receiving treatment in an ICU and those receiving invasive and non-invasive mechanical ventilation during the index hospitalization. Results Antifibrotics were not observed to effect utilization of mechanical ventilation or ICU treatment during the index admission or effect mortality at 30-days. If patients survived hospitalization, mortality was reduced in the treated cohort compared to the untreated cohort when followed up to two years (20.1% vs 47.8%). Conclusions Treatment with antifibrotic medications does not appear to directly improve 30-day mortality during or after respiratory-related hospitalizations. Post-hospital discharge, however, ongoing antifibrotic treatment was associated with improved long-term survival.
Databáze: OpenAIRE
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