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Vol. 60. Issue 2.
Pages 80-87 (February 2024)
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Vol. 60. Issue 2.
Pages 80-87 (February 2024)
Original Article
The Impact of Switching to a Second Antifibrotic in Patients With Idiopathic Pulmonary Fibrosis: A Retrospective Multicentre Study From the EMPIRE Registry
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Jakub Gregora, Yochai Adirb, Martina Šterclovác, Nesrin Mogulkocd, Mordechai R. Kramere, Martina Doubkováf, Martina Plačkovág, Veronika Müllerh, Michael Studnickai, Monika Žurkováj, Ladislav Lacinak, Katarzyna Lewandowskal, Vladimír Bartošm, Petra Ovesnáa, Ondřej Májeka, Martina Koziar Vašákovác,
Corresponding author
martina.koziarvasakova@ftn.cz

Corresponding author.
a Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
b Carmel Medical Center, Haifa, Israel
c Department of Respiratory Medicine, Thomayer University Hospital, Prague, Czech Republic
d Department of Chest Diseases, Faculty of Medicine, Ege University, Izmir, Turkey
e Rabin Medical Centre, Petah Tikva, Israel
f Department of Pulmonary Diseases and Tuberculosis, Faculty of Medicine, Masaryk University and University Hospital Brno, Czech Republic
g Department of Pneumology, University Hospital Ostrava, Czech Republic
h Department of Pulmonology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
i Department of Respiratory Medicine, Paracelsus Medical University Salzburg, Austria
j Department of Respiratory Medicine, University Hospital Olomouc, Czech Republic
k Department of Pneumology and Thoracic Surgery, Hospital Na Bulovce, Prague, Czech Republic
l First Department of Pulmonary Diseases, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
m Department of Pneumology, University Hospital Hradec Králové, Czech Republic
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Figures (5)
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Tables (4)
Table 1. Characteristics of Patients Who Discontinued Their First Antifibrotic Therapy.
Table 2. Reasons for Discontinuing the First Antifibrotic Therapy.
Table 3. The Annual Rate of FVC Decline, Adjusted for Age, Sex and Baseline FVC.
Table 4. Linear Model for Change in FVC (L).
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Additional material (1)
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.

Keywords:
Registries
Antifibrotic agents
Survival
Treatment switch
Abbreviations:
AF
CI
EMPIRE
FVC
GAP
HR
HRCT
INT
IPF
LE
NYHA
OS
PFS
UIP

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