Unmet needs in the treatment of idiopathic pulmonary fibrosis―insights from patient chart review in five European countries

Abstract

BackgroundTwo antifibrotic drugs, pirfenidone and nintedanib, are approved by the European Medicines Agency and the US Food and Drug Administration for the treatment of idiopathic pulmonary fibrosis (IPF). In this analysis, treatment patterns of European patients with IPF were investigated to understand antifibrotic prescribing and identify unmet needs in IPF treatment practice.MethodsBetween February and March 2016, respiratory physicians from France, Germany, Italy, Spain, and the UK participated in an online questionnaire designed to collect information on IPF treatment patterns in patients under their care. Patients were categorized as treated (received approved antifibrotics) or untreated (did not receive approved antifibrotics, but may have received other unapproved therapies). Classification of IPF diagnosis (confirmed/suspected) and severity (‘mild’/‘moderate’/‘severe’) for each patient was based on the individual physician’s report. Patients’ perspectives were not recorded in this study.ResultsIn total, 290 physicians responded to the questionnaire. Overall, 54% of patients with IPF did not receive treatment with an approved antifibrotic. More patients had a confirmed IPF diagnosis in the treated (84%) versus the untreated (51%) population. Of patients with a confirmed diagnosis, 40% did not receive treatment. The treated population was younger than the untreated population (67 vs 70 years, respectively; p ≤ 0.01), with more frequent multidisciplinary team evaluation (83% vs 57%, respectively; p ≤ 0.01). A higher proportion of untreated patients had forced vital capacity > 80% at diagnosis versus treated patients. Of patients with ‘mild’ IPF, 71% did not receive an approved antifibrotic versus 41% and 60% of patients with ‘moderate’ and ‘severe’ IPF, respectively.ConclusionsDespite the availability of antifibrotic therapies, many European patients with confirmed IPF do not receive approved antifibrotic treatment. Importantly, there appears to be a reluctance to treat patients with ‘mild’ or ‘stable’ disease, and instead adopt a ‘watch and wait’ approach. More education is required to address diagnostic uncertainty, poor understanding of IPF and its treatments, and issues of treatment access. There is a need to increase physician awareness of the benefits associated with antifibrotic treatment across the spectrum of IPF severity.Electronic supplementary materialThe online version of this article (10.1186/s12890-017-0468-5) contains supplementary material, which is available to authorized users.

Progressive fibrosing interstitial lung diseases: current practice in diagnosis and management

“…Data from our physician survey suggested that 25-50% of patients with progressive fibrosing ILDs did not receive any drug therapy in the past year. These findings are in line with data from an online survey of 290 European physicians managing patients with IPF conducted in February-March 2016 that indicated that 54% of patients with IPF, and 71% of those with IPF considered to be mild, were not treated with an approved antifibrotic agent 38 . Approximately a third of the pulmonologists and nearly half of the rheumatologists included in our online survey indicated that a primary reason for not initiating therapy in patients with progressive fibrosing ILDs was that patients were considered to have a "mild" level of disease.…”

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

“…Recent evidence from post hoc analyses supports early initiation of antifibrotic therapy once patients have been diagnosed with IPF to reduce loss of lung function and slow disease progression [15][16][17][18]. However, despite the availability of effective treatments, ∼40% of patients with a confirmed diagnosis of IPF do not receive treatment [19].…”

Ongoing challenges in pulmonary fibrosis and insights from the nintedanib clinical programme

“…Real-world data suggest that many patients are not treated with approved IPF therapies immediately after diagnosis, despite the insidious, progressive nature of IPF. In a 2016 European patient chart survey, 53.6% of patients with IPF (N = 1783) were not treated with nintedanib or pirfenidone [36]. A retrospective review of Finnish (n = 158) and Swedish (n = 174) patients with IPF found that, from 2014 to 2016, 45 (29.6%) Finnish and 111 (69.4%) Swedish patients were prescribed nintedanib or pirfenidone [37].…”