Antifibrotic therapy reduces mortality and acute exacerbation in idiopathic pulmonary fibrosis: Chest

(IPF) is a progressive fibrosing interstitial lung disease associated with significant morbidity and mortality. Nintedanib and pirfenidone are two antifibrotic medications currently approved for slowing the rate of lung function decline in IPF, but information on treatment effect on mortality and risk of acute exacerbation (AE) remains limited or unknown.

With this limited background, researchers undertook the study to evaluate whether antifibrotic treatment decrease risk of mortality and AE. The study was designed as a comprehensive search of several databases, including Ovid MEDLINE(R), Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus, was conducted. Studies were included if they were original articles comparing mortality or AE events in IPF patients with and without antifibrotic treatment.

Results revealed some key facts.

• A total of 12,956 patients across 26 studies (8 randomized controlled trials and 18 cohort studies) were included in the meta-analysis.
• Antifibrotic treatment was associated with decreased risk of all-cause mortality with a pooled RR 0.55 (95% CI, 0.45-0.66) and I2 of 82%.
• This effect was consistent across additional subgroup analyses, including stratification by study type, risk of bias, duration of follow-up, and antifibrotic subtype.
• Antifibrotic treatment also reduced the risk of AE, with a pooled RR of 0.63 (95% CI, 0.53-0.76), and I2 of 0%.
• Effect on AE risk was consistent across subgroup analyses by study type and for nintedanib but not for pirfenidone.

"There was a decreased risk of mortality associated with antifibrotic therapy (RR, 0.55). There was also an associated decrease in risk for acute exacerbation with antifibrotic therapy (0.63). The latter was more consistent in patients who received nintedanib versus pirfenidone.This is an important meta-analysis and systematic review, which reveals improvement in mortality and risk of acute exacerbation in patients with IPF receiving antifibrotic therapy. Despite greater heterogeneity with pooled analysis, its effect was robust in subgroup analyses by study type, duration of follow-up, and antifibrotic subtype."the team concluded.

For full article follow the link: https://doi.org/10.1016/j.chest.2021.06.049

Source: Chest