PHYSICIAN CHARACTERISTICS AND TREATMENT STRATEGIES BY PIRFENIDONE DISCONTINUATION RATES IN IDIOPATHIC PULMONARY FIBROSIS: RESULTS FROM AN ONLINE, SELF-ADMINISTERED SURVEY

Abstract

SESSION TITLE: Diffuse Lung Disease SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 pm - 02:00 pm PURPOSE: Pirfenidone is approved for the treatment of idiopathic pulmonary fibrosis (IPF), reduces lung function decline and improves progression-free survival. Although pirfenidone is generally well tolerated, a subset of patients discontinue therapy due to gastrointestinal- and fatigue-related adverse events (AEs). Physician characteristics and treatment strategies stratified by physician-reported patient discontinuation rates due to AEs are described in a varied sample of US pulmonologists. METHODS: An online, self-administered survey was fielded to pulmonologists between April 10 and May 17, 2017. Pulmonologists were included if they spend >20% of their time in direct patient care and had ≥5 patients with IPF receiving antifibrotic therapy. Physicians were stratified by their self-reported proportion of patients discontinuing pirfenidone (≤20% vs. >20%) after answering questions about initiating pirfenidone treatment and management of AEs. RESULTS: A total of 167 pulmonologists responded; 110 (65.9%) and 57 (34.1%) reported ≤20% and >20% of patients discontinuing pirfenidone due to AEs, respectively. In the ≤20% and >20% groups, 41.8% and 36.8%, respectively, practice in an interstitial lung disease center; in both groups, most spend >80% of their time in direct patient care and have 11 to 20 years of experience. More physicians in the ≤20% group practice at an academic medical center vs. the >20% group (63.6% vs. 45.6%, respectively). The mean (SD) number of patients with IPF in each practice was 70.3 (122.7) in the ≤20% group and 60.6 (80.3) in the >20% group. Most physicians in both groups specify when to take pirfenidone relative to a meal (e.g., before, during or after), with the majority counseling during the meal. However, a lower proportion in the ≤20% group recommend during a meal vs. those in the >20% group (56.7% vs. 71.9%, respectively), whereas a higher proportion in the ≤20% group recommend after a meal (28.3% vs. 18.8%, respectively). Physicians in the ≤20% group were less likely to suggest additional therapy to manage AEs, including anti-nausea and anti-diarrheal drugs. Physicians in the ≤20% group were more likely to report strategies to prevent fatigue as being effective than those in the >20% group (33.3% vs. 19.4%, respectively). CONCLUSIONS: Physicians who reported a lower rate of tolerability-related discontinuations (≤20%) had more patients with IPF in their practice. These physicians are more likely to recommend taking pirfenidone after a meal, use fewer additional therapies to manage AEs and reported more-effective strategies to prevent fatigue in their patients vs. physicians with a higher rate of discontinuations (>20%). CLINICAL IMPLICATIONS: Treatment persistence with pirfenidone can be maintained by effective dose titration and AE management strategies. DISCLOSURES: Consultant relationship with Genentech, Inc. Please note: $1001 - $5000 Added 02/21/2018 by Tmirah Haselkorn, source=Web Response, value=Consulting fee No relevant relationships by Peter LaCamera, source=Web Response Employee relationship with Genentech Please note: >$100000 Added 02/23/2018 by Susan Limb, source=Web Response, value=Salary Employee relationship with Genentech, Inc. Please note: >$100000 Added 02/22/2018 by Elizabeth Morgenthien, source=Web Response, value=Salary Stockholder relationship with Roche Please note: $5001 - $20000 Added 02/22/2018 by Elizabeth Morgenthien, source=Web Response, value=Stock Stockholder relationship with Bristol Myers Squibb Please note: $20001 - $100000 Added 02/22/2018 by Elizabeth Morgenthien, source=Web Response, value=Stock Stockholder relationship with Zimmer Please note: $20001 - $100000 Added 02/22/2018 by Elizabeth Morgenthien, source=Web Response, value=Stock Employee Removed 02/22/2018 by John Stauffer, source=Web Response Employee relationship with Genentech, Inc. Please note: $20001 - $100000 Added 02/22/2018 by John Stauffer, source=Web Response, value=Stock holder Speaker/Speaker's Bureau relationship with Genentech, Inc. Please note: $5001 - $20000 Added 02/27/2018 by Mark Wencel, source=Web Response, value=Consulting fee Employee relationship with Genentech, Inc. Please note: >$100000 Added 02/22/2018 by Ming Yang, source=Web Response, value=Salary