Idiopathic Pulmonary Fibrosis in Elderly Patients: Analysis of the INSIGHTS-IPF Observational Study
Background: An association between idiopathic pulmonary fibrosis (IPF) and advancing age is suspected since IPF occurs primarily in patients over 60 years of age. Though, little is known about the disease in the elderly. The aim of this study was to characterize elderly IPF patients using data from...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2020-11-01
|
| Series: | Frontiers in Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2020.601279/full |
| _version_ | 1818298989973340160 |
|---|---|
| author | Gabriela Leuschner Gabriela Leuschner Gabriela Leuschner Jens Klotsche Michael Kreuter Michael Kreuter Antje Prasse Antje Prasse Antje Prasse Hubert Wirtz David Pittrow Marion Frankenberger Marion Frankenberger Jürgen Behr Jürgen Behr Jürgen Behr Nikolaus Kneidinger Nikolaus Kneidinger Nikolaus Kneidinger The INSIGHTS-IPF Registry Group Stefan Andreas Thomas Bahmer Martin Claussen Sven Gläser Christian Grohé Lars Hagmeyer Matthias Held Nicolas Kahn Joachim Kirschner Dirk Koschel Joachim F. Meyer Claus Neurohr Tim Oqueka Martin Schwablmair Dirk Skowasch Tobias Welte Henrike Wilkens |
| author_facet | Gabriela Leuschner Gabriela Leuschner Gabriela Leuschner Jens Klotsche Michael Kreuter Michael Kreuter Antje Prasse Antje Prasse Antje Prasse Hubert Wirtz David Pittrow Marion Frankenberger Marion Frankenberger Jürgen Behr Jürgen Behr Jürgen Behr Nikolaus Kneidinger Nikolaus Kneidinger Nikolaus Kneidinger The INSIGHTS-IPF Registry Group Stefan Andreas Thomas Bahmer Martin Claussen Sven Gläser Christian Grohé Lars Hagmeyer Matthias Held Nicolas Kahn Joachim Kirschner Dirk Koschel Joachim F. Meyer Claus Neurohr Tim Oqueka Martin Schwablmair Dirk Skowasch Tobias Welte Henrike Wilkens |
| author_sort | Gabriela Leuschner |
| collection | DOAJ |
| description | Background: An association between idiopathic pulmonary fibrosis (IPF) and advancing age is suspected since IPF occurs primarily in patients over 60 years of age. Though, little is known about the disease in the elderly. The aim of this study was to characterize elderly IPF patients using data from the longitudinal, German-wide INSIGHTS-IPF registry.Methods: Patients were grouped into elderly (≥75 years) and nonelderly IPF (<75 years) at the time of enrollment into the study. Baseline clinical characteristics, comorbidities, health related quality of life (HRQoL), medical therapy and survival were compared between age groups. Effects of antifibrotic therapy on forced vital capacity (FVC) were analyzed over 24 months.Results: Of 1,009 patients, 350 (34.7%) were ≥75 years old. Elderly IPF patients compared to younger patients had a higher number of comorbidities (3.6 ± 2.5 vs. 2.8 ± 2.3; p < 0.001). The mean ± SD EQ-5D score (0.64 ± 0.21 vs. 0.69 ± 0.21; p = 0.005), and the overall WHO-5 score (13.1 ± 5.9 vs. 14.3 ± 6.0; p = 0.015) were significantly lower while the UCSD-SOBQ (52.6 ± 31.2 vs. 45.5 ± 31.2; p = 0.030) was significantly higher in elderly patients, indicating a more impaired HRQoL and more breathlessness. At baseline, 55.4% of elderly and 56.8% of nonelderly patients with IPF were treated with antifibrotic therapy (p = 0.687). For FVC decline after initiation of antifibrotic therapy, there was neither a significant difference between age groups at the different time points over 24 months (beta: 0.41; 95%-CI: −0.98 to 1.81; p = 0.563) nor over the whole course of time (beta: −0.05; 95%-CI: −0.20 to 0.09; p = 0.478). All-cause mortality was higher in elderly patients (49.1 vs. 37.9%; HR 1.65; 95%-CI 1.36–2.00; p < 0.001). Antifibrotic therapy was associated with improved survival in IPF patients, independent from age (<75 years: beta 0.76; 95%-CI: 0.59–0.99; p = 0.049; ≥75 years: beta 0.71; 95%-CI: 0.51–0.98; p = 0.043).Conclusion: In real life, a significant proportion of IPF patients are ≥75 years old, characterized by higher number of comorbidities and global reduced HRQoL. However, the effect of an antifibrotic therapy was similar between age groups and associated with a survival benefit emphasizing the importance for an early antifibrotic therapy in IPF, independent from age. |
| first_indexed | 2024-12-13T04:44:06Z |
| format | Article |
| id | doaj.art-0080099672704217ad17730a789ef896 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-13T04:44:06Z |
| publishDate | 2020-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-0080099672704217ad17730a789ef8962022-12-21T23:59:12ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2020-11-01710.3389/fmed.2020.601279601279Idiopathic Pulmonary Fibrosis in Elderly Patients: Analysis of the INSIGHTS-IPF Observational StudyGabriela Leuschner0Gabriela Leuschner1Gabriela Leuschner2Jens Klotsche3Michael Kreuter4Michael Kreuter5Antje Prasse6Antje Prasse7Antje Prasse8Hubert Wirtz9David Pittrow10Marion Frankenberger11Marion Frankenberger12Jürgen Behr13Jürgen Behr14Jürgen Behr15Nikolaus Kneidinger16Nikolaus Kneidinger17Nikolaus Kneidinger18The INSIGHTS-IPF Registry GroupStefan AndreasThomas BahmerMartin ClaussenSven GläserChristian GrohéLars HagmeyerMatthias HeldNicolas KahnJoachim KirschnerDirk KoschelJoachim F. MeyerClaus NeurohrTim OquekaMartin SchwablmairDirk SkowaschTobias WelteHenrike WilkensComprehensive Pneumology Center (CPC-M), Asklepios Klinik Gauting and Helmholtz Center Munich, Ludwig-Maximilians University, München, GermanyDepartment of Internal Medicine V, Ludwig-Maximilian University Munich, Munich, GermanyGerman Center for Lung Research, München, GermanyEpidemiology, German Rheumatism Research Center, A Leibniz Institute, Berlin, GermanyGerman Center for Lung Research, München, GermanyCenter for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, Heidelberg, GermanyGerman Center for Lung Research, München, GermanyKlinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, GermanyFraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, GermanyAbteilung für Pneumologie, Department Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Leipzig, GermanyInstitut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität Dresden, Dresden, GermanyComprehensive Pneumology Center (CPC-M), Asklepios Klinik Gauting and Helmholtz Center Munich, Ludwig-Maximilians University, München, GermanyGerman Center for Lung Research, München, GermanyComprehensive Pneumology Center (CPC-M), Asklepios Klinik Gauting and Helmholtz Center Munich, Ludwig-Maximilians University, München, GermanyDepartment of Internal Medicine V, Ludwig-Maximilian University Munich, Munich, GermanyGerman Center for Lung Research, München, GermanyComprehensive Pneumology Center (CPC-M), Asklepios Klinik Gauting and Helmholtz Center Munich, Ludwig-Maximilians University, München, GermanyDepartment of Internal Medicine V, Ludwig-Maximilian University Munich, Munich, GermanyGerman Center for Lung Research, München, GermanyBackground: An association between idiopathic pulmonary fibrosis (IPF) and advancing age is suspected since IPF occurs primarily in patients over 60 years of age. Though, little is known about the disease in the elderly. The aim of this study was to characterize elderly IPF patients using data from the longitudinal, German-wide INSIGHTS-IPF registry.Methods: Patients were grouped into elderly (≥75 years) and nonelderly IPF (<75 years) at the time of enrollment into the study. Baseline clinical characteristics, comorbidities, health related quality of life (HRQoL), medical therapy and survival were compared between age groups. Effects of antifibrotic therapy on forced vital capacity (FVC) were analyzed over 24 months.Results: Of 1,009 patients, 350 (34.7%) were ≥75 years old. Elderly IPF patients compared to younger patients had a higher number of comorbidities (3.6 ± 2.5 vs. 2.8 ± 2.3; p < 0.001). The mean ± SD EQ-5D score (0.64 ± 0.21 vs. 0.69 ± 0.21; p = 0.005), and the overall WHO-5 score (13.1 ± 5.9 vs. 14.3 ± 6.0; p = 0.015) were significantly lower while the UCSD-SOBQ (52.6 ± 31.2 vs. 45.5 ± 31.2; p = 0.030) was significantly higher in elderly patients, indicating a more impaired HRQoL and more breathlessness. At baseline, 55.4% of elderly and 56.8% of nonelderly patients with IPF were treated with antifibrotic therapy (p = 0.687). For FVC decline after initiation of antifibrotic therapy, there was neither a significant difference between age groups at the different time points over 24 months (beta: 0.41; 95%-CI: −0.98 to 1.81; p = 0.563) nor over the whole course of time (beta: −0.05; 95%-CI: −0.20 to 0.09; p = 0.478). All-cause mortality was higher in elderly patients (49.1 vs. 37.9%; HR 1.65; 95%-CI 1.36–2.00; p < 0.001). Antifibrotic therapy was associated with improved survival in IPF patients, independent from age (<75 years: beta 0.76; 95%-CI: 0.59–0.99; p = 0.049; ≥75 years: beta 0.71; 95%-CI: 0.51–0.98; p = 0.043).Conclusion: In real life, a significant proportion of IPF patients are ≥75 years old, characterized by higher number of comorbidities and global reduced HRQoL. However, the effect of an antifibrotic therapy was similar between age groups and associated with a survival benefit emphasizing the importance for an early antifibrotic therapy in IPF, independent from age.https://www.frontiersin.org/articles/10.3389/fmed.2020.601279/fullagingelderlyantifibrotic therapyprognosismultivariate analysis |
| spellingShingle | Gabriela Leuschner Gabriela Leuschner Gabriela Leuschner Jens Klotsche Michael Kreuter Michael Kreuter Antje Prasse Antje Prasse Antje Prasse Hubert Wirtz David Pittrow Marion Frankenberger Marion Frankenberger Jürgen Behr Jürgen Behr Jürgen Behr Nikolaus Kneidinger Nikolaus Kneidinger Nikolaus Kneidinger The INSIGHTS-IPF Registry Group Stefan Andreas Thomas Bahmer Martin Claussen Sven Gläser Christian Grohé Lars Hagmeyer Matthias Held Nicolas Kahn Joachim Kirschner Dirk Koschel Joachim F. Meyer Claus Neurohr Tim Oqueka Martin Schwablmair Dirk Skowasch Tobias Welte Henrike Wilkens Idiopathic Pulmonary Fibrosis in Elderly Patients: Analysis of the INSIGHTS-IPF Observational Study Frontiers in Medicine aging elderly antifibrotic therapy prognosis multivariate analysis |
| title | Idiopathic Pulmonary Fibrosis in Elderly Patients: Analysis of the INSIGHTS-IPF Observational Study |
| title_full | Idiopathic Pulmonary Fibrosis in Elderly Patients: Analysis of the INSIGHTS-IPF Observational Study |
| title_fullStr | Idiopathic Pulmonary Fibrosis in Elderly Patients: Analysis of the INSIGHTS-IPF Observational Study |
| title_full_unstemmed | Idiopathic Pulmonary Fibrosis in Elderly Patients: Analysis of the INSIGHTS-IPF Observational Study |
| title_short | Idiopathic Pulmonary Fibrosis in Elderly Patients: Analysis of the INSIGHTS-IPF Observational Study |
| title_sort | idiopathic pulmonary fibrosis in elderly patients analysis of the insights ipf observational study |
| topic | aging elderly antifibrotic therapy prognosis multivariate analysis |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2020.601279/full |
| work_keys_str_mv | AT gabrielaleuschner idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT gabrielaleuschner idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT gabrielaleuschner idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT jensklotsche idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT michaelkreuter idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT michaelkreuter idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT antjeprasse idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT antjeprasse idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT antjeprasse idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT hubertwirtz idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT davidpittrow idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT marionfrankenberger idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT marionfrankenberger idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT jurgenbehr idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT jurgenbehr idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT jurgenbehr idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT nikolauskneidinger idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT nikolauskneidinger idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT nikolauskneidinger idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT theinsightsipfregistrygroup idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT stefanandreas idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT thomasbahmer idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT martinclaussen idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT svenglaser idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT christiangrohe idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT larshagmeyer idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT matthiasheld idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT nicolaskahn idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT joachimkirschner idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT dirkkoschel idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT joachimfmeyer idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT clausneurohr idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT timoqueka idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT martinschwablmair idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT dirkskowasch idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT tobiaswelte idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy AT henrikewilkens idiopathicpulmonaryfibrosisinelderlypatientsanalysisoftheinsightsipfobservationalstudy |