The Impact of Switching to a Second Antifibrotic in Patients With Idiopathic Pulmonary Fibrosis: A Retrospective Multicentre Study From the EMPIRE Registry

• Jakub Gregor ^[3] ; Yochai Adir ^[4] ; Martina Šterclová ^[5] ; Nesrin Mogulkoc ^[1] ; Mordechai R. Kramer ^[6] ; Martina Doubková ^[7] ; Martina Plačková ^[8] ; Veronika Müller ^[2] ; Michael Studnicka ^[9] ; Monika Žurková ^[10] ; Ladislav Lacina ^[11] ; Katarzyna Lewandowska ^[12] ; Vladimír Bartoš ^[13] ; Petra Ovesná ^[3] ; Ondřej Májek ^[3] ; Martina Koziar Vašáková ^[5]
  1. [1] Ege University

     Ege University

     Turquía

     
  2. [2] Semmelweis University

     Semmelweis University

     Hungría

     
  3. [3] Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
  4. [4] Carmel Medical Center, Haifa, Israel
  5. [5] Department of Respiratory Medicine, Thomayer University Hospital, Prague, Czech Republic
  6. [6] Rabin Medical Centre, Petah Tikva, Israel
  7. [7] Department of Pulmonary Diseases and Tuberculosis, Faculty of Medicine, Masaryk University and University Hospital Brno, Czech Republic
  8. [8] Department of Pneumology, University Hospital Ostrava, Czech Republic
  9. [9] Department of Respiratory Medicine, Paracelsus Medical University Salzburg, Austria
  10. [10] Department of Respiratory Medicine, University Hospital Olomouc, Czech Republic
  11. [11] Department of Pneumology and Thoracic Surgery, Hospital Na Bulovce, Prague, Czech Republic
  12. [12] First Department of Pulmonary Diseases, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
  13. [13] Department of Pneumology, University Hospital Hradec Králové, Czech Republic

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• Localización: Archivos de bronconeumología: Organo oficial de la Sociedad Española de Neumología y Cirugía Torácica SEPAR y la Asociación Latinoamericana de Tórax ( ALAT ), ISSN 0300-2896, Vol. 60, Nº. 2, 2024, págs. 80-87
• Idioma: inglés
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• Resumen

  • 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: −98 ml/y in switched and −172 ml/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.