IPF patients benefit from early antifibrotic therapy

An observational study assessed the influence of earlier versus later therapy with the tyrosine kinase inhibitor nintedanib in patients diagnosed with idiopathic pulmonary fibrosis. Early therapy was associated with fewer hospitalisations and a reduction of all-cause medical costs.

Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease characterised by progressive lung function decline and a poor prognosis with a median survival time ranging from 2.5 to 3.5 years [1]. In posthoc analyses of placebo-controlled studies, the tyrosine kinase inhibitor nintedanib consistently decelerated lung function decline by ~50% among patients with preserved or reduced lung function [2,3]. However, the debate is ongoing on when to initiate treatment in a real-life setting. Therefore, a posthoc analysis presented during ATS 2021 assessed medical costs and risk of hospitalisation among patients with IPF by the timing of nintedanib initiation within 12 months after diagnosis [3]. The observational study included administrative claims data on insured patients aged ≥40 years with ≥2 medical claims with an IPF diagnosis on separate dates from 01 Oct 2014 to 30 Jun 2019 [4]. All participants were enrolled for at least 6 months before IPF diagnosis and up to 13 months after for cost analysis, or 12 months after for hospitalisation analysis. The researchers retrospectively analysed data on all-cause 12-month medical costs and all-cause follow-up hospitalisation. As information such as forced vital capacity value is not readily available in claims data, proxies (e.g., oxygen use) were utilised as markers for disease severity and included as confounder in the statistical analysis.

Study cohorts were analysed according to time from IPF diagnosis to treatment initiation (1, 2–3, 4–6, or 7–12 months). The study sample consisted of 449 patients with a mean age of 72 years; the majority were men (68%), as expected in an IPF population. Baseline all-cause medical utilisation and associated costs were comparable between cohorts.

Adjusted 12-month all-cause medical costs and adjusted all-cause hospitalisation risk differed by the timing of nintedanib initiation (P=0.020 and P<0.001, respectively). All-cause hospitalisation risk was significantly higher among patients who were not yet treated versus patients treated before the end of months 2–3 (P=0.026), 4–6 (P=0.014), and 7–12 (P<0.001). In addition, 12-month all-cause medical costs were 69% higher for patients who initiated treatment in months 2–3 versus month 1. Costs were numerically higher but not statistically different for patients starting therapy in months 4–6 and 7–12 versus month 1.

The authors concluded that early therapy soon after the IPF diagnosis may have reduced hospitalisation risk and was associated with lower medical costs. The reason for the benefit of early treatment might be due to the preservation of lung function in IPF, which obviously translates into a measurable real-world benefit.

1. Ley B, et al. Am J Resp Crit Care Med 2011;183(4): 431-40.
2. Costabel U et al. Am J Respir Crit Care Med. 2016;193(2):178-185.
3. Kolb M et al. Thorax 2017; 72(4):340-346.
4. Singer D, et al. Impact of timing of nintedanib initiation among patients newly diagnosed with idiopathic pulmonary fibrosis. Session TP15: Diffuse parenchymal lung diseases: ILD, sarcoidosis, IPF, LAM, ATS 2021 International conference, 14-19 May 2021.

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Posted on 5 July, 2021