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The impact of nintedanib and pirfenidone on lung function and survival in patients with idiopathic pulmonary fibrosis in real-life setting

Data de publicação: Data Ahead of Print:

Autores da FMUP

  • Hélder Novais E Bastos

    Autor

  • Antonio Manuel Martins De Morais

    Autor

Participantes de fora da FMUP

  • Santos, G
  • Fabiano, A
  • Mota, PC
  • Rodrigues, I
  • Carvalho, D
  • Melo, N
  • Alexandre, AT
  • Moura, CS
  • Guimaraes, S
  • Pereira, JM
  • Carvalho, A

Unidades de investigação

Abstract

Background: Idiopathic pulmonary fibrosis (IPF) is a chronic, fibrosing interstitial pneumonia of unknown cause that is associated with radiological and/or histological features of usual interstitial pneumonia (UIP). A mean survival of 2-5 years was reported previously to the advent of antifibrotics. According to clinical trials, ninte-danib and pirfenidone induce a significant delay in functional decline, with a favorable impact on survival.Methods: A real-life retrospective and longitudinal study was conducted to assess the efficacy and tolerability of antifibrotics in IPF patients, between January 2014 and December 2020. Two groups (under nintedanib or pirfenidone) were analyzed at diagnosis through their clinical features and radiological patterns. Lung function was assessed at diagnosis (time 0) and after 6, 12 and 24 months of treatment. We also compared this antifibrotic cohort with an older naive antifibrotic cohort, mainly treated with immunosuppressive drugs and/or N- ace-tylcysteine. Survival was analyzed and prognostic features were also studied. Statistical analysis was performed with IBM (R) SPSS (R).Results: A cohort of 108 patients under antifibrotics (nintedanib n = 54; pirfenidone n = 54) was assessed. Lung function analysis showed an overall stabilization in FVC and DLCO mean predicted percentages at 6, 12 and 24 months of treatment. The mean decline in FVC and DLCO, at 12 months, was-40.95 +/- 438.26 mL and-0.626 +/- 1.31 mL/min/mmHg, respectively. However, during this period, 34.2% of the patients died mostly due to acute exacerbation associated with a poorer lung function at diagnosis. Mean survival in the naive antifibrotic cohort was significantly lower than in the antifibrotic cohort (39.9 months versus 58.2 months; p < 0.005). Regarding lung function evolution and survival, we found no differences between definitive or probable UIP radiological patterns, both on patients under nintedanib and pirfenidone (p = 0.656).Conclusions: In this real-life observational study, the positive impact of antifibrotic therapy on the IPF clinical course and on survival was corroborated. Regarding efficacy, there was no difference between patients taking nintedanib or pirfenidone. The need for an early treatment was also demonstrated, since a worse outcome is clearly associated with lower lung volumes and lower diffusing capacity at diagnosis.

Dados da publicação

ISSN/ISSNe:
1094-5539, 1522-9629

PULMONARY PHARMACOLOGY & THERAPEUTICS  Academic Press Inc.

Tipo:
Article
Páginas:
-
Link para outro recurso:
www.scopus.com

Citações Recebidas na Web of Science: 1

Citações Recebidas na Scopus: 5

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Keywords

  • Idiopathic pulmonary fibrosis; Antifibrotics; Nintedanib; Pirfenidone

Campos de estudo

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