Identifying Barriers to Idiopathic Pulmonary Fibrosis Treatment: A Survey of Patient and Physician Views

Abstract

Background: Antifibrotics are recommended for the treatment of individuals with idiopathic pulmonary fibrosis (IPF), but treatment use remains at ∼60%. Objective: To investigate the views of individuals with IPF and pulmonologists on the diagnosis and management of IPF to understand treatment patterns. Methods: Interviews and/or online surveys were completed by patients and pulmonologists from Canada, France, Germany, Italy, Spain, and the UK. Responses from physicians were analyzed by time between diagnosis and treatment initiation in the majority of patients with IPF (group A, > 4 months; group B, ≤4 months). Statistical comparisons between physicians were undertaken using z tests, with p < 0.05 considered statistically significant. Results: The physicians in group A saw fewer patients, were less comfortable discussing the IPF prognosis with patients, and had less belief in the benefits of antifibrotic treatments than the physicians in group B. These physicians’ attitudes contrasted with those of the patients, who wanted more information about the IPF prognosis and pharmacological treatment options at diagnosis and were more concerned about preventing disease progression than avoiding medication side effects. Differences between countries were found regarding physicians’ comfort in discussing the prognosis at diagnosis and access to care. Conclusions: Several barriers to antifibrotic treatment, principally reflecting the differing views and values of patients and physicians, were identified in this study, suggesting a need for better patient-physician communication about pharmacological therapy for IPF.

Rationale, design and objectives of two phase III, randomised, placebo-controlled studies of GLPG1690, a novel autotaxin inhibitor, in idiopathic pulmonary fibrosis (ISABELA 1 and 2)

“…ISABELA 1 and 2, two identically designed, phase III studies, will provide efficacy, safety and QoL data from subjects with IPF treated with GLPG1690 in addition to local SOC. Although antifibrotic agents are recommended for the treatment of IPF, approximately 40% of patients do not receive them 41 42. Furthermore, while both pirfenidone and nintedanib slow physiological disease progression, substantial declines in FVC still occur (–145 mL with pirfenidone in ASCEND43; –114.7 mL and –113.6 mL with nintedanib in INPULSIS-1 and INPULSIS-2,13 respectively), neither benefits QoL, and while survival is likely prolonged by treatment with these agents, IPF-related mortality remains high and the majority of patients still die due to respiratory failure 44.…”

Patient and site characteristics associated with pirfenidone and nintedanib use in the United States; an analysis of idiopathic pulmonary fibrosis patients enrolled in the Pulmonary Fibrosis Foundation Patient Registry

“…Real world experiences with anti-fibrotic use have also been reported for a single Italian center [8] and in England using administrative data [9]. Additionally, surveys have been used to explore patient and provider views about IPF treatment in Canada, France, Germany, Italy, Spain and the United Kingdom [10]. These surveys suggest that provider characteristics may affect prescription patterns and therefore may be important to patient outcomes.…”

Efficacy and safety of nintedanib in patients with advanced idiopathic pulmonary fibrosis

“…b Corresponds to MedDRA term 'IPF', which included disease worsening and acute exacerbations. c Reported in > 1.5% of patients in any of the groups shown, based on MedDRA preferred terms concerns over the tolerability of antifibrotic therapies in patients who are old or have comorbidities [20]. However, many of the patients with IPF who require care in clinical practice have advanced impairment in lung function.…”