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Leuschner G, Klotsche J, Kreuter M, Prasse A, Wirtz H, Pittrow D, Frankenberger M, Behr J, Kneidinger N. Idiopathic Pulmonary Fibrosis in Elderly Patients: Analysis of the INSIGHTS-IPF Observational Study. Front Med (Lausanne) 2020; 7:601279. [PMID: 33313046 PMCID: PMC7703706 DOI: 10.3389/fmed.2020.601279] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/09/2020] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Gabriela Leuschner
- Comprehensive Pneumology Center (CPC-M), Asklepios Klinik Gauting and Helmholtz Center Munich, Ludwig-Maximilians University, München, Germany.,Department of Internal Medicine V, Ludwig-Maximilian University Munich, Munich, Germany.,German Center for Lung Research, München, Germany
| | - Jens Klotsche
- Epidemiology, German Rheumatism Research Center, A Leibniz Institute, Berlin, Germany
| | - Michael Kreuter
- German Center for Lung Research, München, Germany.,Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Antje Prasse
- German Center for Lung Research, München, Germany.,Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Germany.,Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Hubert Wirtz
- Abteilung für Pneumologie, Department Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Leipzig, Germany
| | - David Pittrow
- Institut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - Marion Frankenberger
- Comprehensive Pneumology Center (CPC-M), Asklepios Klinik Gauting and Helmholtz Center Munich, Ludwig-Maximilians University, München, Germany.,German Center for Lung Research, München, Germany
| | - Jürgen Behr
- Comprehensive Pneumology Center (CPC-M), Asklepios Klinik Gauting and Helmholtz Center Munich, Ludwig-Maximilians University, München, Germany.,Department of Internal Medicine V, Ludwig-Maximilian University Munich, Munich, Germany.,German Center for Lung Research, München, Germany
| | - Nikolaus Kneidinger
- Comprehensive Pneumology Center (CPC-M), Asklepios Klinik Gauting and Helmholtz Center Munich, Ludwig-Maximilians University, München, Germany.,Department of Internal Medicine V, Ludwig-Maximilian University Munich, Munich, Germany.,German Center for Lung Research, München, Germany
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Behr J, Prasse A, Wirtz H, Koschel D, Pittrow D, Held M, Klotsche J, Andreas S, Claussen M, Grohé C, Wilkens H, Hagmeyer L, Skowasch D, Meyer JF, Kirschner J, Gläser S, Kahn N, Welte T, Neurohr C, Schwaiblmair M, Bahmer T, Oqueka T, Frankenberger M, Kreuter M. Survival and course of lung function in the presence or absence of antifibrotic treatment in patients with idiopathic pulmonary fibrosis: long-term results of the INSIGHTS-IPF registry. Eur Respir J 2020; 56:13993003.02279-2019. [DOI: 10.1183/13993003.02279-2019] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/07/2020] [Indexed: 11/05/2022]
Abstract
ObjectiveThere is a paucity of observational data on antifibrotic therapy for idiopathic pulmonary fibrosis (IPF). We aimed to assess the course of disease of IPF patients with and without antifibrotic therapy under real-life conditions.MethodsWe analysed data from a non-interventional, prospective cohort study of consecutively enrolled IPF patients from 20 interstitial lung disease expert centres in Germany. Data quality was ensured by automated plausibility checks, on-site monitoring, and source data verification. Propensity scores were applied to account for known differences in baseline characteristics between patients with and without antifibrotic therapy.ResultsAmong the 588 patients suitable for analysis, the mean±sd age was 69.8±9.1 years, and 81.0% were male. The mean±sd duration of disease since diagnosis was 1.8±3.4 years. The mean±sd value at baseline for forced vital capacity (FVC) and diffusion capacity (DLCO) were 68.6±18.8% predicted and 37.8±18.5% predicted, respectively. During a mean±sd follow-up of 1.2±0.7 years, 194 (33.0%) patients died. The 1-year and 2-year survival rates were 87% versus 46% and 62% versus 21%, respectively, for patients with versus without antifibrotic therapy. The risk of death was 37% lower in patients with antifibrotic therapy (hazard ratio 0.63, 95% CI 0.45; 0.87; p=0.005). The results were robust (and remained statistically significant) on multivariable analysis. Overall decline of FVC and DLCO was slow and did not differ significantly between patients with or without antifibrotic therapy.ConclusionsSurvival was significantly higher in IPF patients with antifibrotic therapy, but the course of lung function parameters was similar in patients with and without antifibrotic therapy. This suggests that in clinical practice, premature mortality of IPF patients eventually occurs despite stable measurements for FVC and DLCO.
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Kreuter M, Swigris J, Pittrow D, Geier S, Klotsche J, Prasse A, Wirtz H, Koschel D, Andreas S, Claussen M, Grohé C, Wilkens H, Hagmeyer L, Skowasch D, Meyer JF, Kirschner J, Gläser S, Kahn N, Welte T, Neurohr C, Schwaiblmair M, Held M, Bahmer T, Oqueka T, Frankenberger M, Behr J. The clinical course of idiopathic pulmonary fibrosis and its association to quality of life over time: longitudinal data from the INSIGHTS-IPF registry. Respir Res 2019; 20:59. [PMID: 30876420 PMCID: PMC6420774 DOI: 10.1186/s12931-019-1020-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/27/2019] [Indexed: 02/06/2023] Open
Abstract
Background Quality of life (QoL) is profoundly impaired in patients with idiopathic pulmonary fibrosis (IPF). However, data is limited regarding the course of QoL. We therefore analysed longitudinal data from the German INSIGHTS-IPF registry. Methods Clinical status and QoL were assessed at enrollment and subsequently at 6- to 12-months intervals. A range of different QoL questionnaires including the St. George’s Respiratory Questionnaire (SGRQ) were used. Results Data from 424 patients were included; 76.9% male; mean age 68.7 ± 9.1 years, mean FVC% predicted 75.9 ± 19.4, mean DLCO% predicted 36.1 ± 15.9. QoL worsened significantly during follow-up with higher total SGRQ scores (increased by 1.47 per year; 95% CI: 1.17 to 1.76; p < 0.001) and higher UCSD-SOBQ scores and lower EQ-5D VAS and WHO-5 scores. An absolute decline in FVC% predicted of > 10% was associated with a significant deterioration in SGRQ (increasing by 9.08 units; 95% CI: 2.48 to 15.67; p = 0.007), while patients with stable or improved FVC had no significantly change in SGRQ. Patients with a > 10% decrease of DLCO % predicted also had a significant increase in SGRQ (+ 7.79 units; 95% CI: 0.85 to 14.73; p = 0.028), while SQRQ was almost stable in patients with stable or improved DLCO. Patients who died had a significant greater increase in SGRQ total scores (mean 11.8 ± 18.6) at their last follow-up visit prior to death compared to survivors (mean 4.2 ± 18.9; HR = 1.03; 95% CI: 1.01 to 1.04; p < 0.001). All QoL scores across the follow-up period were significantly worse in hospitalised patients compared to non-hospitalised patients, with the worst scores reported in those hospitalised for acute exacerbations. Conclusions QoL assessments in the INSIGHTS-IPF registry demonstrate a close relationship between QoL and clinically meaningful changes in lung function, comorbidities, disease duration and clinical course of IPF, including hospitalisation and mortality. Electronic supplementary material The online version of this article (10.1186/s12931-019-1020-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael Kreuter
- Center for interstitial and rare lung diseases, Thoraxklinik, University of Heidelberg, Röntgenstr 1, D-69126, Heidelberg, Germany. .,German Center for Lung Research, gießen, Germany.
| | - Jeff Swigris
- Interstitial Lung Disease Program, National Jewish Health, Denver, CO, USA
| | - David Pittrow
- Institut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - Silke Geier
- Department Market Access, Boehringer Ingelheim, Ingelheim am Rhein, Germany
| | - Jens Klotsche
- Epidemiologie, Deutsches Rheuma-Forschungsinstitut, Berlin, Germany
| | - Antje Prasse
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Germany.,Fraunhofer Institute ITEM, Hannover, Germany.,German Center for Lung Research, gießen, Germany
| | - Hubert Wirtz
- Abteilung für Pneumologie, Department Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Leipzig, Germany
| | - Dirk Koschel
- Zentrum für Pneumologie und Bereich Pneumologie, Fachkrankenhaus Coswig und Uniklinikum Dresden, Coswig, Germany
| | - Stefan Andreas
- Lungenfachklinik Immenhausen and Universitätsmedizin Göttingen, Kardiologie und Pneumologie, Göttingen, Germany
| | - Martin Claussen
- Lungen Clinic Grosshansdorf, Grosshansdorf, Germany.,German Center for Lung Research, gießen, Germany
| | | | - Henrike Wilkens
- Klinik für Innere Medizin V, Pneumologie, Universitätsklinikum Universitätskliniken des Saarlandes, Homburg, Germany
| | | | - Dirk Skowasch
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Joachim F Meyer
- Lungenzentrum München, LZM Bogenhausen-Harlaching, Städtisches Klinikum München GmbH, Munich, Germany
| | | | - Sven Gläser
- Klinik und Poliklinik für Innere Medizin B, Forschungsbereich Pneumologie und Pneumologische Epidemiologie, Universitätsmedizin Greifswald, Greifswald, Germany.,Vivantes Klinikum Spandau, Klinik für Innere Medizin, Berlin, Germany
| | - Nicolas Kahn
- Center for interstitial and rare lung diseases, Thoraxklinik, University of Heidelberg, Röntgenstr 1, D-69126, Heidelberg, Germany.,German Center for Lung Research, gießen, Germany
| | - Tobias Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Germany.,German Center for Lung Research, gießen, Germany
| | - Claus Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der LMU, Munich, Germany.,Schillerhöhe, Robert Bosch Krankenhaus, Stuttgart, Germany
| | | | - Matthias Held
- Klinikum Würzburg Mitte, Standort Missioklinik, Abteilung Innere Medizin, Pneumologie, Würzburg, Germany
| | - Thomas Bahmer
- Lungen Clinic Grosshansdorf, Grosshansdorf, Germany.,German Center for Lung Research, gießen, Germany
| | - Tim Oqueka
- Universitätsklinikum Hamburg, Hamburg, Germany
| | - Marion Frankenberger
- Medizinische Klinik und Poliklinik V, Klinikum der LMU, Munich, Germany.,Asklepios Fachkliniken München-Gauting, Munich, Germany.,German Center for Lung Research, gießen, Germany
| | - Jürgen Behr
- Medizinische Klinik und Poliklinik V, Klinikum der LMU, Munich, Germany.,Asklepios Fachkliniken München-Gauting, Munich, Germany.,German Center for Lung Research, gießen, Germany
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Kreuter M, Swigris J, Pittrow D, Geier S, Klotsche J, Prasse A, Wirtz H, Koschel D, Andreas S, Claussen M, Grohé C, Wilkens H, Hagmeyer L, Skowasch D, Meyer JF, Kirschner J, Gläser S, Herth FJF, Welte T, Neurohr C, Schwaiblmair M, Held M, Bahmer T, Frankenberger M, Behr J. Health related quality of life in patients with idiopathic pulmonary fibrosis in clinical practice: insights-IPF registry. Respir Res 2017; 18:139. [PMID: 28709421 PMCID: PMC5512739 DOI: 10.1186/s12931-017-0621-y] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 07/03/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The INSIGHTS-IPF registry provides one of the largest data sets of clinical data and self-reported patient related outcomes including health related quality of life (QoL) on patients with idiopathic pulmonary fibrosis (IPF). We aimed to describe associations of various QoL instruments between each other and with patient characteristics at baseline. METHODS Six hundred twenty-three IPF patients with available QoL data (St George's Respiratory Questionnaire SGRQ, UCSD Shortness-of-Breath Questionnaire SoB, EuroQol visual analogue scale and index EQ-5D, Well-being Index WHO-5) were analysed. Mean age was 69.6 ± 8.7 years, 77% were males, mean disease duration 2.0 ± 3.3 years, FVC pred was 67.5 ± 17.8%, DLCO pred 35.6 ± 17%. RESULTS Mean points were SGRQ total 48.3, UCSD SoB 47.8, EQ-5D VAS 66.8, and WHO-5 13.9. These instruments had a high or very high correlation (exception WHO-5 to EQ-5D VAS with moderate correlation). On bivariate analysis, QoL by SGRQ total was statistically significantly associated with clinical symptoms (NYHA; p < 0.001), number of comorbidities (p < 0.05), hospitalisation rate (p < 0.01) and disease severity (as measured by GAP score, CPI, FVC and 6-min walk test; p < 0.05 each). Multivariate analyses showed a significant association between QoL (by SGRQ total) and IPF duration, FVC, age, NYHA class and indication for long-term oxygen treatment. CONCLUSIONS Overall, IPF patients under real-life conditions have lower QoL compared to those in clinical studies. There is a meaningful relationship between QoL and various patient characteristics. TRIAL REGISTRATION The INSIGHTS-IPF registry is registered at Clinicaltrials.gov ( NCT01695408 ).
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Affiliation(s)
- Michael Kreuter
- Center for interstitial and rare lung diseases, pneumology and respiratory critical care medicine, Thoraxklinik, University of Heidelberg, Röntgenstr. 1, D-69126 Heidelberg, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
| | - Jeff Swigris
- Interstitial Lung Disease Program, National Jewish Health, Denver, CO USA
| | - David Pittrow
- Institut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität Dresden, Dresden, Germany
| | - Silke Geier
- Department Market Access, Boehringer Ingelheim, Ingelheim am Rhein, Germany
| | - Jens Klotsche
- Epidemiologie, Deutsches Rheuma-Forschungsinstitut, Berlin, Germany
| | - Antje Prasse
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Germany
- Fraunhofer Institute ITEM, Hannover, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
| | - Hubert Wirtz
- Abteilung für Pneumologie, Department Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig AöR, Leipzig, Germany
| | - Dirk Koschel
- Zentrum für Pneumologie, Fachkrankenhaus Coswig, Coswig, Germany
| | - Stefan Andreas
- Lungenfachklinik Immenhausen and Universitätsmedizin Göttingen, Kardiologie und Pneumologie, Göttingen, Germany
| | - Martin Claussen
- LungenClinic Grosshansdorf, Grosshansdorf, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
| | | | - Henrike Wilkens
- Klinik für Innere Medizin V, Pneumologie, Universitätsklinikum Universitätskliniken des Saarlandes, Homburg, Germany
| | | | - Dirk Skowasch
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Joachim F Meyer
- Lungenzentrum München, LZM Bogenhausen-Harlaching, Städtisches Klinikum München GmbH, München, Germany
| | | | - Sven Gläser
- Universitätsmedizin Greifswald, Klinik und Poliklinik für Innere Medizin B, Forschungsbereich Pneumologie und Pneumologische Epidemiologie, Greifswald, Germany
- Vivantes Klinikum Spandau, Klinik für Innere Medizin, Berlin, Germany
| | - Felix J. F. Herth
- Center for interstitial and rare lung diseases, pneumology and respiratory critical care medicine, Thoraxklinik, University of Heidelberg, Röntgenstr. 1, D-69126 Heidelberg, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
| | - Tobias Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
| | - Claus Neurohr
- Comprehensive Pneumology Center, Lungenforschungsambulanz, Klinikum der Universität München, München, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
| | | | - Matthias Held
- Klinikum Würzburg Mitte, Standort Missioklinik, Abteilung Innere Medizin, Pneumologie, Würzburg, Germany
| | - Thomas Bahmer
- LungenClinic Grosshansdorf, Grosshansdorf, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
| | - Marion Frankenberger
- Comprehensive Pneumology Center, Lungenforschungsambulanz, Klinikum der Universität München, München, Germany
- Asklepios Fachkliniken München-Gauting, München, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
| | - Jürgen Behr
- Comprehensive Pneumology Center, Lungenforschungsambulanz, Klinikum der Universität München, München, Germany
- Asklepios Fachkliniken München-Gauting, München, Germany
- German center for Lung Research, Aulweg 130, 35392 Gießen, Germany
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Kreuter M, Bonella F, Wijsenbeek M, Maher TM, Spagnolo P. Pharmacological Treatment of Idiopathic Pulmonary Fibrosis: Current Approaches, Unsolved Issues, and Future Perspectives. BIOMED RESEARCH INTERNATIONAL 2015; 2015:329481. [PMID: 26779535 PMCID: PMC4686637 DOI: 10.1155/2015/329481] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/11/2015] [Indexed: 12/29/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a devastating condition with a 5-year survival of approximately 20%. The disease primarily occurs in elderly patients. IPF is a highly heterogeneous disorder with a clinical course that varies from prolonged periods of stability to episodes of rapid deterioration. In the last decade, improved understanding of disease mechanisms along with a more precise disease definition has allowed the design and completion of a number of high-quality clinical trials. Yet, until recently, IPF was essentially an untreatable disease. Finally, pirfenidone and nintedanib, two compounds with antifibrotic properties, have consistently proven effective in reducing functional decline and disease progression in IPF. This is a major breakthrough for patients and physicians alike, but there is still a long way to go. In fact, neither pirfenidone nor nintedanib is a cure for IPF, and most patients continue to progress despite treatment. As such, comprehensive care of patients with IPF, including management of comorbidities/complications and physical debility and timely referral for palliative care or, in a small number of highly selected patients, lung transplantation, remains essential. Several agents with high potential are currently being tested and many more are ready to be evaluated in clinical trials.
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Affiliation(s)
- Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, 69126 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRCH), Member of the German Center for Lung Research (DZL), 69126 Heidelberg, Germany
| | - Francesco Bonella
- Interstitial and Rare Lung Disease Unit, Ruhrlandklinik, University Hospital, University of Duisburg-Essen, 45141 Essen, Germany
| | - Marlies Wijsenbeek
- Department of Pulmonary Disease, Erasmus Medical Centre, University Hospital Rotterdam, 3015 CE Rotterdam, Netherlands
| | - Toby M. Maher
- National Institute for Health Research Biological Research Unit, Royal Brompton Hospital, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, London SW3 6NP, UK
| | - Paolo Spagnolo
- Medical University Clinic, Canton Hospital Baselland and University of Basel, 4410 Liestal, Switzerland
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Behr J, Kreuter M, Hoeper MM, Wirtz H, Klotsche J, Koschel D, Andreas S, Claussen M, Grohé C, Wilkens H, Randerath W, Skowasch D, Meyer FJ, Kirschner J, Gläser S, Herth FJF, Welte T, Huber RM, Neurohr C, Schwaiblmair M, Kohlhäufl M, Höffken G, Held M, Koch A, Bahmer T, Pittrow D. Management of patients with idiopathic pulmonary fibrosis in clinical practice: the INSIGHTS-IPF registry. Eur Respir J 2015; 46:186-96. [PMID: 25837040 PMCID: PMC4486374 DOI: 10.1183/09031936.00217614] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 02/03/2015] [Indexed: 11/26/2022]
Abstract
After introduction of the new international guidelines on idiopathic pulmonary fibrosis (IPF) in 2011, we investigated clinical management practices for patients with IPF according to physicians' diagnoses. A prospective, multicenter, noninterventional study with comprehensive quality measures including on-site source data verification was performed in Germany. 502 consecutive patients (171 newly diagnosed, 331 prevalent; mean±SD age 68.7±9.4 years, 77.9% males) with a mean disease duration of 2.3±3.5 years were enrolled. IPF diagnosis was based on clinical assessments and high-resolution computed tomography (HRCT) in 90.2%, and on surgical lung biopsy combined with histology in 34.1% (lavage in 61.8%). The median 6-min walk distance was 320 m (mean 268±200 m). The mean forced vital capacity was 72±20% pred and diffusing capacity of the lung for carbon monoxide was 35±15% pred. No drugs were administered in 17.9%, oral steroids in 23.7%, N-acetylcysteine in 33.7%, pirfenidone in 44.2% and other drugs in 4.6% of patients. Only 2.8% of the cohort was listed for lung transplantation. IPF patients were diagnosed in line with the new guidelines. They had more severe disease than those enrolled in recent randomised controlled trials. In addition to HRCT, the frequency of lung biopsies was surprisingly high. Treatment patterns varied substantially.
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Affiliation(s)
| | | | | | | | | | - Dirk Koschel
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Stefan Andreas
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Martin Claussen
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Christian Grohé
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Henrike Wilkens
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Winfried Randerath
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Dirk Skowasch
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - F Joachim Meyer
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Joachim Kirschner
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Sven Gläser
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Felix J F Herth
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Tobias Welte
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Rudolf Maria Huber
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Claus Neurohr
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Martin Schwaiblmair
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Martin Kohlhäufl
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Gert Höffken
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Matthias Held
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Andrea Koch
- For the authors' affiliations, see the Acknowledgements Study steering committee members
| | - Thomas Bahmer
- For the authors' affiliations, see the Acknowledgements Study steering committee members
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Behr J, Hoeper MM, Kreuter M, Klotsche J, Wirtz H, Pittrow D. Investigating significant health trends in idiopathic pulmonary fibrosis (INSIGHTS-IPF): rationale, aims and design of a nationwide prospective registry. BMJ Open Respir Res 2014; 1:e000010. [PMID: 25478169 PMCID: PMC4212719 DOI: 10.1136/bmjresp-2013-000010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 11/25/2013] [Indexed: 12/02/2022] Open
Abstract
Background Guidelines on the diagnosis and management of idiopathic pulmonary fibrosis (IPF), a rare manifestation of chronic progressive fibrosing interstitial pneumonia, have been updated by ATS/ERS/JRS/ALAT in 2011. In Europe, data are limited on the characteristics and management of such patients. Methods/design Investigating significant health trends (INSIGHTS)-IPF is a prospective observational longitudinal registry designed to describe the characteristics and management of newly diagnosed (incident) and prevalent patients with IPF on the long term. The registry uses a non-probability sampling approach to collect data on characteristics, therapeutic interventions, health-related quality of life and health economic parameters. At least 500 patients in ambulatory care will be included consecutively in about 30 centres. The study has been initiated in November 2012, and currently (December 2013) follows 344 patients. ClinTrials.gov identifier is NCT01695408. Discussion INSIGHTS-IPF documents one of the largest IPF cohorts in Europe. The registry is expected to provide much-needed data on the characteristics and management situation of patients with IPF in Germany. It will allow comparisons with other countries. Gap analyses based on current guidelines for management of these patients will be possible.
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Affiliation(s)
- Juergen Behr
- Department of Internal Medicine V , Comprehensive Pneumology Center, University of Munich and Asklepios Fachkliniken München-Gauting , Munich , Germany
| | - Marius M Hoeper
- Department of Respiratory Medicine , Hannover Medical School , Hannover , Germany
| | - Michael Kreuter
- Department of Pneumology and Respiratory Critical Care Medicine , Thoraxklinik, University of Heidelberg , Heidelberg , Germany
| | - Jens Klotsche
- Department of Epidemiology , German Rheumatism Research Centre, Leibniz Institute , Berlin , Germany
| | - Hubert Wirtz
- Department of Respiratory Medicine , University of Leipzig , Leipzig , Germany
| | - David Pittrow
- Medical Faculty , Institute for Clinical Pharmacology, Technical University , Dresden , Germany
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Kaunisto J, Salomaa ER, Hodgson U, Kaarteenaho R, Myllärniemi M. Idiopathic pulmonary fibrosis--a systematic review on methodology for the collection of epidemiological data. BMC Pulm Med 2013; 13:53. [PMID: 23962167 PMCID: PMC3765635 DOI: 10.1186/1471-2466-13-53] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 08/14/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Recent studies suggest that the incidence of idiopathic pulmonary fibrosis (IPF) is rising. Accurate epidemiological data on IPF, however, are sparse and the results of previous studies are contradictory. This study was undertaken to gain insight into the various methods used in the epidemiological research of IPF, and to get accurate and comparable data on these different methodologies. METHODS A systematic database search was performed in order to identify all epidemiological studies on IPF after the previous guidelines for diagnosis and treatment were published in 2000. Medline (via Pubmed), Science Sitation Index (via Web of Science) and Embase databases were searched for original epidemiological articles published in English in international peer-reviewed journals starting from 2001. After pre-screening and a full-text review, 13 articles were accepted for data abstraction. RESULTS Three different methodologies of epidemiological studies were most commonly used, namely: (1) national registry databases, (2) questionnaire-based studies, and (3) analysis of the health care system's own registry databases. The overall prevalence and incidence of IPF varied in these studies between 0.5-27.9/100,000 and 0.22-8.8/100,000, respectively. According to four studies the mortality and incidence of IPF are rising. CONCLUSIONS We conclude that there are numerous ways to execute epidemiological research in the field of IPF. This review offers the possibility to compare the different methodologies that have been used, and this information could form a basis for future studies investigating the prevalence and incidence of IPF.
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Affiliation(s)
- Jaana Kaunisto
- Division of Medicine, Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Eija-Riitta Salomaa
- Division of Medicine, Pulmonary Diseases, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Ulla Hodgson
- Division of Pulmonary Medicine, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Riitta Kaarteenaho
- Center for Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland
- Unit of Medicine and Clinical Research, Pulmonary Division, University of Eastern Finland, Kuopio, Finland
- Respiratory Research Unit and Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Marjukka Myllärniemi
- Division of Pulmonary Medicine, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
- Departement of Clinical Medicine, Division of Pulmonary Medicine, University of Helsinki, Biomedicum, PoBox 63, 00014, Helsinki C405b, Finland
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