Switching antifibrotics in patients with idiopathic pulmonary fibrosis: a multi-center retrospective cohort study
Abstract Background Currently, there are two antifibrotics used to treat idiopathic pulmonary fibrosis (IPF): pirfenidone and nintedanib. Antifibrotics slow disease progression by reducing the annual decline of forced vital capacity (FVC), which possibly improves outcomes in IPF patients. During tre...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-07-01
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| Series: | BMC Pulmonary Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12890-021-01587-3 |
| _version_ | 1819070976273416192 |
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| author | Yuzo Suzuki Kazutaka Mori Yuya Aono Masato Kono Hirotsugu Hasegawa Koshi Yokomura Hyogo Naoi Hironao Hozumi Masato Karayama Kazuki Furuhashi Noriyuki Enomoto Tomoyuki Fujisawa Yutaro Nakamura Naoki Inui Hidenori Nakamura Takafumi Suda |
| author_facet | Yuzo Suzuki Kazutaka Mori Yuya Aono Masato Kono Hirotsugu Hasegawa Koshi Yokomura Hyogo Naoi Hironao Hozumi Masato Karayama Kazuki Furuhashi Noriyuki Enomoto Tomoyuki Fujisawa Yutaro Nakamura Naoki Inui Hidenori Nakamura Takafumi Suda |
| author_sort | Yuzo Suzuki |
| collection | DOAJ |
| description | Abstract Background Currently, there are two antifibrotics used to treat idiopathic pulmonary fibrosis (IPF): pirfenidone and nintedanib. Antifibrotics slow disease progression by reducing the annual decline of forced vital capacity (FVC), which possibly improves outcomes in IPF patients. During treatment, patients occasionally switch antifibrotic treatments. However, prognostic implication of changing antifibrotics has not yet been evaluated. Methods This multi-center retrospective cohort study examined 262 consecutive IPF patients who received antifibrotic therapy. Antifibrotic agents were switched in 37 patients (14.1%). The prognoses were compared between the patient cohort that switched antifibrotics (Switch-IPF) and those without (Non-Switch-IPF) using propensity-score matched analyses. Results The median period between the initiation of antifibrotic therapy and the drug switch was 25.8 (12.7–35.3) months. The most common reasons for the switch were disease progression (n = 17) followed by gastrointestinal disorders (n = 12). Of the 37 patients that switched antifibrotics, only eight patients disrupted switched antifibrotics by their adverse reactions. The overall prognosis of the Switch-IPF cohort was significantly better than the Non-Switch-IPF cohort (median periods: 67.2 vs. 27.1 months, p < 0.0001). In propensity-score matched analyses that were adjusted to age, sex, FVC (%), history of acute exacerbation, and usage of long-term oxygen therapy, the Switch-IPF cohort had significantly longer survival times than the Non-Switch-IPF group (median 67.2 vs. 41.3 months, p = 0.0219). The second-line antifibrotic therapy showed similar survival probabilities than those in first-line antifibrotic therapy in multistate model analyses. Conclusion Switching antifibrotics is feasible and may improve prognosis in patients with IPF. A further prospective study will be required to confirm clinical implication of switching the antifibrotics. |
| first_indexed | 2024-12-21T17:14:29Z |
| format | Article |
| id | doaj.art-4dbda5c1c00342a09b5cd06cd44651aa |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-12-21T17:14:29Z |
| publishDate | 2021-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-4dbda5c1c00342a09b5cd06cd44651aa2022-12-21T18:56:20ZengBMCBMC Pulmonary Medicine1471-24662021-07-0121111310.1186/s12890-021-01587-3Switching antifibrotics in patients with idiopathic pulmonary fibrosis: a multi-center retrospective cohort studyYuzo Suzuki0Kazutaka Mori1Yuya Aono2Masato Kono3Hirotsugu Hasegawa4Koshi Yokomura5Hyogo Naoi6Hironao Hozumi7Masato Karayama8Kazuki Furuhashi9Noriyuki Enomoto10Tomoyuki Fujisawa11Yutaro Nakamura12Naoki Inui13Hidenori Nakamura14Takafumi Suda15Second Division, Department of Internal Medicine, Hamamatsu University School of MedicineDepartment of Respiratory Medicine, Shizuoka City Shimizu HospitalSecond Division, Department of Internal Medicine, Hamamatsu University School of MedicineDepartment of Respiratory Medicine, Seirei Hamamatsu General HospitalDepartment of Respiratory Medicine, Seirei Mikatahara General HospitalDepartment of Respiratory Medicine, Seirei Mikatahara General HospitalSecond Division, Department of Internal Medicine, Hamamatsu University School of MedicineSecond Division, Department of Internal Medicine, Hamamatsu University School of MedicineSecond Division, Department of Internal Medicine, Hamamatsu University School of MedicineSecond Division, Department of Internal Medicine, Hamamatsu University School of MedicineSecond Division, Department of Internal Medicine, Hamamatsu University School of MedicineSecond Division, Department of Internal Medicine, Hamamatsu University School of MedicineSecond Division, Department of Internal Medicine, Hamamatsu University School of MedicineSecond Division, Department of Internal Medicine, Hamamatsu University School of MedicineDepartment of Respiratory Medicine, Seirei Hamamatsu General HospitalSecond Division, Department of Internal Medicine, Hamamatsu University School of MedicineAbstract Background Currently, there are two antifibrotics used to treat idiopathic pulmonary fibrosis (IPF): pirfenidone and nintedanib. Antifibrotics slow disease progression by reducing the annual decline of forced vital capacity (FVC), which possibly improves outcomes in IPF patients. During treatment, patients occasionally switch antifibrotic treatments. However, prognostic implication of changing antifibrotics has not yet been evaluated. Methods This multi-center retrospective cohort study examined 262 consecutive IPF patients who received antifibrotic therapy. Antifibrotic agents were switched in 37 patients (14.1%). The prognoses were compared between the patient cohort that switched antifibrotics (Switch-IPF) and those without (Non-Switch-IPF) using propensity-score matched analyses. Results The median period between the initiation of antifibrotic therapy and the drug switch was 25.8 (12.7–35.3) months. The most common reasons for the switch were disease progression (n = 17) followed by gastrointestinal disorders (n = 12). Of the 37 patients that switched antifibrotics, only eight patients disrupted switched antifibrotics by their adverse reactions. The overall prognosis of the Switch-IPF cohort was significantly better than the Non-Switch-IPF cohort (median periods: 67.2 vs. 27.1 months, p < 0.0001). In propensity-score matched analyses that were adjusted to age, sex, FVC (%), history of acute exacerbation, and usage of long-term oxygen therapy, the Switch-IPF cohort had significantly longer survival times than the Non-Switch-IPF group (median 67.2 vs. 41.3 months, p = 0.0219). The second-line antifibrotic therapy showed similar survival probabilities than those in first-line antifibrotic therapy in multistate model analyses. Conclusion Switching antifibrotics is feasible and may improve prognosis in patients with IPF. A further prospective study will be required to confirm clinical implication of switching the antifibrotics.https://doi.org/10.1186/s12890-021-01587-3Antifibrotic therapyIdiopathic pulmonary fibrosisSwitch of antifibrotics |
| spellingShingle | Yuzo Suzuki Kazutaka Mori Yuya Aono Masato Kono Hirotsugu Hasegawa Koshi Yokomura Hyogo Naoi Hironao Hozumi Masato Karayama Kazuki Furuhashi Noriyuki Enomoto Tomoyuki Fujisawa Yutaro Nakamura Naoki Inui Hidenori Nakamura Takafumi Suda Switching antifibrotics in patients with idiopathic pulmonary fibrosis: a multi-center retrospective cohort study BMC Pulmonary Medicine Antifibrotic therapy Idiopathic pulmonary fibrosis Switch of antifibrotics |
| title | Switching antifibrotics in patients with idiopathic pulmonary fibrosis: a multi-center retrospective cohort study |
| title_full | Switching antifibrotics in patients with idiopathic pulmonary fibrosis: a multi-center retrospective cohort study |
| title_fullStr | Switching antifibrotics in patients with idiopathic pulmonary fibrosis: a multi-center retrospective cohort study |
| title_full_unstemmed | Switching antifibrotics in patients with idiopathic pulmonary fibrosis: a multi-center retrospective cohort study |
| title_short | Switching antifibrotics in patients with idiopathic pulmonary fibrosis: a multi-center retrospective cohort study |
| title_sort | switching antifibrotics in patients with idiopathic pulmonary fibrosis a multi center retrospective cohort study |
| topic | Antifibrotic therapy Idiopathic pulmonary fibrosis Switch of antifibrotics |
| url | https://doi.org/10.1186/s12890-021-01587-3 |
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