BACKGROUND: Pragmatic use of the anti-fibrotic medications pirfenidone and nintedanib for idiopathic pulmonary fibrosis (IPF) in the United States (US) has not been studied and may be different from international settings due to structural differences between health care systems. This study examined the relationship between patient- and site-level characteristics and anti-fibrotic (a) use and (b) selection.
METHODS: Data from the Pulmonary Fibrosis Foundation Patient Registry was used to perform univariable and multivariable regressions with generalized linear mixed models. A random effects model examined registry site variation.
RESULTS: 703 of 1218 (57.7%) patients were taking a single anti-fibrotic of which 312 (44.4%) were taking nintedanib and 391 (55.6%) were taking pirfenidone. Up to 25% of patients using an anti-fibrotic may have been excluded from clinical trial participation due to having too severe disease as measured by diffusion limitation for carbon monoxide. Age (OR = 0.974, p = 0.0086) and diffusion capacity of the lungs for carbon monoxide (per 10% increase in percent-predicted; OR = 0.896, p = 0.0007) was negatively associated with anti-fibrotic use while time (in log of days) since diagnosis (OR = 1.138, p < 0.0001), recent patient clinical trial participation (OR = 1.569, p = 0.0433) and oxygen use (OR = 1.604, p = 0.0027) was positively associated with anti-fibrotic use. Time (log of days) since diagnosis (OR = 1.075, p = 0.0477), history of coronary artery disease (OR = 1.796, p = 0.0030), presence of pulmonary hypertension (OR = 2.139, p = 0.0376), patient clinical trial participation in the prior 12 months (OR = 2.485, p = 0.0002), diffusion capacity of the lungs for carbon monoxide (per 10% increase in percent-predicted; OR = 1.138, p = 0.0184), anticoagulant use (OR = 2.507, p = 0.0028), and enrollment at a registry site in the Midwest region (OR = 1.600, p = 0.0446) were associated with pirfenidone use. Anti-fibrotic use varied by registry site. Rates of discontinuation were modest and nearly identical for the two medications with side effects being the most common reason given for discontinuation. Twenty-three percent (23%, 274) of persons with IPF were using or had recently used an immunomodulatory agent.
CONCLUSIONS: This analysis provides a detailed characterization of IPF treatment patterns in the US; many users of anti-fibrotic medications may not have qualified for inclusion in clinical trials. More research is needed to understand variations in medical decision-making for use and selection of anti-fibrotic medication.
Bibliographical noteFunding Information:
CH is supported by NIH Grant No. T32 HL007749–26. EF is a managing director of the SABER unit within the department of biostatistics at the University of Michigan. SABER receives funding from the Pulmonary Fibrosis Foundation. JS, SL and KR are employees of Genentech. WP is a former employee of Genentech. He is currently employed at BioMarin. KF reports personal fees from Veracyte and Sanofi Genzyme; and grants and personal fees from Roche/Genentech and Boehringer Ingelheim, outside of the submitted work. HK has served as site principle investigator for IPF clinical trials sponsored by InterMune, Gilead, Sanofi, Celgene, and Centocor.
© 2020 The Author(s).
- Aged, 80 and over
- Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
- Idiopathic Pulmonary Fibrosis/drug therapy
- Indoles/therapeutic use
- Middle Aged
- Patient Participation/trends
- Protein Kinase Inhibitors/therapeutic use
- Pyridones/therapeutic use
- United States/epidemiology
PubMed: MeSH publication types
- Journal Article