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Gregor J, Adir Y, Šterclová M, Mogulkoc N, Kramer MR, Doubková M, Plačková M, Müller V, Studnicka M, Žurková M, Lacina L, Lewandowska K, Bartoš V, Ovesná P, Májek O, Koziar Vašáková M. The Impact of Switching to a Second Antifibrotic in Patients With Idiopathic Pulmonary Fibrosis: A Retrospective Multicentre Study From the EMPIRE Registry. Arch Bronconeumol 2024; 60:80-87. [PMID: 38160169 DOI: 10.1016/j.arbres.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Most patients with idiopathic pulmonary fibrosis (IPF) treated with antifibrotics (AF) have progressive disease despite treatment. A switch of AF may improve survival, but evidence from randomised controlled trials is missing. We aimed to evaluate the efficacy of an AF switch on survival and FVC decline in patients from the European MultiPartner IPF registry (EMPIRE). METHODS The study included 612 patients who discontinued the first antifibrotic therapy. Patients were grouped and analysed from two perspectives: (1) whether they had received a second antifibrotic treatment after the discontinuation of the first therapy, and (2) a reason for discontinuation of the first AF - "lack of efficacy" (LE) and "intolerance" (INT). RESULTS While 263 (43%) of 612 patients received no second AF ("non-switched"), 349 (57%) patients switched. Overall survival was higher in patients who received a second AF (median 50 vs. 29 months; adjusted HR 0.64, P=0.023). Similarly, the annual FVC decline was significantly reduced in switched patients: -98ml/y in switched and -172ml/y in non-switched patients (P=0.023), respectively. The switched patients had similar risk for mortality in both LE and INT groups (adjusted HR 0.95, P=0.85). The high impact of switching on survival was demonstrated in LE patients (adjusted HR 0.27, P<0.001). CONCLUSION The patients without a second AF had significantly shorter overall survival. Our analysis suggests the importance of switching patients with an ineffective first AF therapy to a second AF therapy.
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Affiliation(s)
- Jakub Gregor
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Martina Šterclová
- Department of Respiratory Medicine, Thomayer University Hospital, Prague, Czech Republic
| | - Nesrin Mogulkoc
- Department of Chest Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
| | | | - Martina Doubková
- Department of Pulmonary Diseases and Tuberculosis, Faculty of Medicine, Masaryk University and University Hospital Brno, Czech Republic
| | - Martina Plačková
- Department of Pneumology, University Hospital Ostrava, Czech Republic
| | - Veronika Müller
- Department of Pulmonology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Michael Studnicka
- Department of Respiratory Medicine, Paracelsus Medical University Salzburg, Austria
| | - Monika Žurková
- Department of Respiratory Medicine, University Hospital Olomouc, Czech Republic
| | - Ladislav Lacina
- Department of Pneumology and Thoracic Surgery, Hospital Na Bulovce, Prague, Czech Republic
| | - Katarzyna Lewandowska
- First Department of Pulmonary Diseases, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Vladimír Bartoš
- Department of Pneumology, University Hospital Hradec Králové, Czech Republic
| | - Petra Ovesná
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ondřej Májek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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