Healthcare resource use and associated costs in patients receiving pirfenidone or nintedanib for idiopathic pulmonary fibrosis

Cottin, Vincent; Spagnolo, Paolo; Bonniaud, Philippe; Dalon, Faustine; Nolin, M.; Kirchgässler, Klaus-Uwe; Ganse, Éric Van; Belhassen, Manon

doi:10.1016/j.resmer.2022.100951

Cited by 1 publication

(1 citation statement)

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“…However, the multicenter IPF-PRO analysis found a similar increase in hospitalization hazard and posited it was secondary to a likely combination of unmeasured confounding between treated and untreated groups, a potentially unintended result of longer survival of patients on antifibrotics, and the closer monitoring within the healthcare system that can occur with patients on antifibrotics. While an increase in general healthcare utilization has not been clearly associated with antifibrotic use compared to those not on antifibrotics, one study comparing nintedanib to pirfenidone did find higher global healthcare costs for patients on nintedanib [17]. Interestingly, patients on antifibrotic treatment had fewer symptoms at baseline compared to untreated patients.…”

Section: Discussionmentioning

confidence: 99%

The impact of antifibrotic use on long-term clinical outcomes in the pulmonary fibrosis foundation registry

Lee,

Hao,

Burg

et al. 2024

Respir Res

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Background Idiopathic pulmonary fibrosis (IPF) is a devastating interstitial lung disease (ILD) with a high mortality rate. The antifibrotic medications pirfenidone and nintedanib have been in use since 2014 for this disorder and are associated with improved rate of lung function decline. Less is known about their long-term outcomes outside of the clinical trial context. Methods The Pulmonary Fibrosis Foundation Patient Registry was used for this study. Patients with an IPF diagnosis made within a year of enrollment were included. The treated group was defined as patients receiving either pirfenidone or nintedanib for at least 180 days. The untreated group did not have any record of antifibrotic use. Demographic data, comorbidities, serial lung function, hospitalization, and vital status data were collected from the registry database. The primary outcomes were transplant-free survival, time to first respiratory hospitalization, and time to 10% absolute FVC decline. Time-to-event analyses were performed utilizing Cox proportional hazards models and the log-rank test. Model covariates included age, gender, smoking history, baseline lung function, comorbidities, and oxygen use. Results The registry contained 1212 patients with IPF; ultimately 288 patients met inclusion criteria for the treated group, and 101 patients were designated as untreated. Patients treated with antifibrotics were significantly younger (69.8 vs. 72.6 years, p = 0.008) and less likely to have smoked (61.1% ever smokers vs. 72.3% never smokers, p = 0.04). No significant differences were seen in race, gender, comorbidities, or baseline pulmonary function between groups. The primary outcome of transplant-free survival was not significantly different between the two groups (adjusted HR 0.799, 95% CI 0.534–1.197, p = 0.28). Time to respiratory hospitalization was significantly shorter in the treated group (adjusted HR 2.12, 95% CI 1.05–4.30, p = 0.04). No significant difference in time to pulmonary function decline was seen between groups. Conclusions This multicenter study demonstrated 63% of newly diagnosed IPF patients had continuous antifibrotic usage. Antifibrotics were not associated with improved transplant-free survival or pulmonary function change but was associated with an increased hazard of respiratory hospitalization. Future studies should further investigate the role of antifibrotic therapy in clinically important outcomes in real-world patients with IPF and other progressive ILDs.

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Section: Discussionmentioning

confidence: 99%