Comparison of Treatment Methods and Responsiveness Between Patients With Usual Interstitial Pneumonia and Possible Usual Interstitial Pneumonia Radiographic Patterns

Abstract

SESSION TITLE: Diffuse Lung Disease 1 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: The usual interstitial pneumonia (UIP) pattern of radiographic and histologic findings is commonly associated with idiopathic pulmonary fibrosis (IPF), although it can be associated with secondary interstitial lung diseases (ILD). Based on the radiographic findings, ILD can be classified as “UIP, “possible UIP”, or “inconsistent with UIP.” The purpose of this study is to analyze and compare treatment patterns and responsiveness between UIP and possible UIP radiographic patterns. METHODS: 220 patients seen and evaluated at Rush University Medical Center and/or Rush Oak Park Hospital for newly diagnosed interstitial lung disease were identified. Patients with previous workup, incomplete workup, or with an “inconsistent with UIP” pattern on radiography were excluded (180 patients). Patients were then split into the categories “UIP” or “possible UIP” based on the radiologist’s read of high-resolution CT. The rates of use of immunosuppressants and other medications (including anti-fibrotic agents, such as pirfenidone and nintedanib) were compared between the two groups. Response to treatment was also analyzed based on PFT data, using a cutoff of a 10% change in VC, TLC, or DLCO. Fisher’s exact tests compared frequencies between groups. RESULTS: 40 patients met inclusion criteria. There were 11 total pulmonologists who evaluated these patients. 13 patients had the UIP pattern and 27 patients had possible UIP, based on the radiologist’s read of a high-resolution CT scan. 8 UIP patients were treated with immunosuppressants, compared to 11 possible UIP patients (p = 0.3140); 2 UIP patients were treated with other medications, compared to 7 possible UIP patients (p = 0.6904). In UIP patients, 2 had improved VC, 5 had stable VC, and 3 had a worsened VC, compared to 1 improved, 12 stable, and 9 worsened VCs in possible UIP patients (p = 0.406). 1 UIP patient demonstrated improvement in TLC, 5 showed stable TLC, and 2 had a worsened TLC, compared to 2 improved, 13 stable, and 7 worsened TLCs in possible UIP patients (p = 0.999). Finally, for UIP, 1 patient had improved DLCO, 3 had stable DLCOs, and 4 had worsened DLCO, compared to 4 improved, 7 stable, and 11 worsened DLCOs in possible UIP (p = 0 .999). There were no statistically significant changes in PFTs when comparing UIP patients treated with immunosuppressants or other medications to those not treated; similarly, there were no statistically significant changes in PFT data comparing treated possible UIP pattern patients to those not treated. 3 out of the 13 typical UIP patients had a biopsy, compared to 8 of the 27 possible UIP patients (p = 1.000). CONCLUSIONS: Patients with both UIP and possible UIP patterns on radiographic imaging are more commonly treated with immunosuppressants. Despite this, there is no statistically significant improvement or prevention of decline in treated or untreated patients. CLINICAL IMPLICATIONS: Possible UIP and typical UIP patients tend to have similarly poor response to treatment with antifibrotic agent and immunosuppresants. When treating ILD with a UIP pattern, providers should carefully weigh subjective benefits against the risks of immunosuppressant or antifibrotic therapies. DISCLOSURE: The following authors have nothing to disclose: Krishnan Warrior, Mark Yoder No Product/Research Disclosure Information