Antifibrotics can improve the long-term survival of idiopathic pulmonary fibrosis (IPF) patients after they are discharged from the hospital. However, they do not seem to improve 30-day mortality during or after hospitalization due to respiratory-related admissions. This is according to the findings of a new study by researchers at the Mayo Clinic.
This finding is important because it can guide decision-making on treatment strategies of patients with IPF.
Antifibrotic medications such as nintedanib and pirfenidone can reduce the decline in lung function, hospitalization rate, and mortality in patients with IPF. However, there is little data available on their effect on mortality following hospitalization due to respiratory-related complications.
In the present study, a team of researchers led by Andrew H. Limper, MD, used data from a large US insurance database to elucidate the effect of antifibrotics on mortality in patients with IPF who were hospitalized between January 1, 2015, and December 31, 2018, due to respiratory-related problems. The researchers evaluated mortality at 30 days and up to 2 years following hospitalization.
They found that the use of antifibrotics did not have an effect on the use of mechanical ventilation or the need for intensive care treatment during the first admission to the hospital. It also did not have an effect on mortality at 30 days.
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However, if patients survived hospitalization and were discharged, those treated with antifibrotics had reduced mortality (20.1%), compared to those who were not treated (47.8%).
“Treatment with antifibrotic medications does not appear to directly improve 30-day mortality during or after respiratory-related hospitalizations,” the researchers wrote. “Post-hospital discharge, however, ongoing antifibrotic treatment was associated with improved long-term survival,” they added.
There is currently no cure for IPF. Antifibrotics like nintedanib and pirfenidone became pharmacological options for the treatment of the disease following their approval by the US Food and Drug Administration (FDA) on October 15, 2014. Research has shown that they both reduce the rate of progression of the disease but may cause adverse effects requiring dosage modifications.
Kelly BT, Thao V, Dempsey TM, et al. Outcomes for hospitalized patients with idiopathic pulmonary fibrosis treated with antifibrotic medications. BMC Pulm Med. 2021;21(1):239. doi:10.1186/s12890-021-01607-2.
Raghu G, Selman M. Nintedanib and pirfenidone. New antifibrotic treatments indicated for idiopathic pulmonary fibrosis offer hopes and raises questions. Am J Respir Crit Care Med. 2015;191(3):252-254. doi:10.1164/rccm.201411-2044ED