Therapeutic decisions regarding initiation of antifibrotic therapy in IPF: a multicenter, prospective cohort study from Poland.

Abstract

Pirfenidone and nintedanib are two antifibrotic drugs that modify the course of idiopathic pulmonary fibrosis (IPF), however both agents differ in terms of outcome and safety of use. <b>Objective:</b> To provide, under real-world conditions, an analysis of the therapeutic decisions of pulmonary specialists, particularly the choice of the antifibrotic drug in patients with IPF. <b>Methods:</b> This was a multicenter, prospective survey collecting clinical data of patients with IPF. Clinical characteristics and information on the therapeutic approach were retrieved. Among others, multiple logistic regression analysis with stepwise model selection was used. <b>Results:</b> 188 pths (74.5% M, aged 73(IQR 68-78)years) were considered for antifibrotic therapy in the study period. 138 received treatment. Disqualification from treatment was mainly due to lack of patient consent and IPF severity. Of all the pths qualified for antifibrotic treatment, 72 received pirfenidone, 66 received nintedanib. Dose protocol and patient preference were associated with the choice of nintedanib (p&lt;0.01 and p=0.049, respectively). The comorbidity profile and concomitant medication use were associated with the choice of pirfenidone (p=0.0003 and p=0.03, respectively). Age (p=0.002), TLco (p=0.001) and gastrointestinal bleeding (p=0.03), were significantly associated with the qualification for the antifibrotic treatment. <b>Conclusion:</b> The majority of pths considered for IPF treatment were qualified for antifibrotic therapy.&nbsp;Dose protocol and patient preference were associated with the choice of nintedanib, while&nbsp;comorbidity profile and concomitant medication with the choice of pirfenidone.