Patient and site characteristics associated with pirfenidone and nintedanib use in the United States; an analysis of idiopathic pulmonary fibrosis patients enrolled in the Pulmonary Fibrosis Foundation Patient Registry

• Published in: Respiratory research 2020-02, Vol.21 (1), p.48-48, Article 48
• Main Authors: Holtze, Colin H, Freiheit, Elizabeth A, Limb, Susan L, Stauffer, John L, Raimundo, Karina, Pan, Wayne T, Flaherty, Kevin R, Kim, Hyun J
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Anticoagulants; Carbon monoxide; Cardiovascular disease; Characterization; Chronic obstructive pulmonary disease; Clinical decision making; Clinical trials; Coronary artery; Coronary artery disease; Coronary heart disease; Decision making; Development and progression; Diagnosis; Diffusion; Diffusion rate; Disease control; Diseases; Drug therapy; Drugs; Enrollments; Female; Fibrosis; Foundations - trends; Gastroesophageal reflux; Heart diseases; Humans; Hypertension; Idiopathic pulmonary fibrosis; Idiopathic Pulmonary Fibrosis - drug therapy; Idiopathic Pulmonary Fibrosis - epidemiology; Immunomodulation; Indoles - therapeutic use; Lung diseases; Lungs; Male; Medical research; Middle Aged; Nintedanib; Participation; Patient outcomes; Patient Participation - trends; Patients; Pirfenidone; Protein Kinase Inhibitors - therapeutic use; Pulmonary fibrosis; Pulmonary hypertension; Pyridones - therapeutic use; Reason; Registries; Regression analysis; Rehabilitation; Respiratory tract diseases; Setting (Literature); Side effects; Sleep apnea; Statistical models; Therapeutics; Time; United States - epidemiology; Variables
• ISSN: 1465-993X; 1465-9921; 1465-993X; 1465-9921
• DOI: 10.1186/s12931-020-1315-4

Pragmatic use of the anti-fibrotic medications pirfenidone and nintedanib for idiopathic pulmonary fibrosis (IPF) in the United States (US) has not been studied and may be different from international settings due to structural differences between health care systems. This study examined the relationship between patient- and site-level characteristics and anti-fibrotic (a) use and (b) selection. Data from the Pulmonary Fibrosis Foundation Patient Registry was used to perform univariable and multivariable regressions with generalized linear mixed models. A random effects model examined registry site variation. 703 of 1218 (57.7%) patients were taking a single anti-fibrotic of which 312 (44.4%) were taking nintedanib and 391 (55.6%) were taking pirfenidone. Up to 25% of patients using an anti-fibrotic may have been excluded from clinical trial participation due to having too severe disease as measured by diffusion limitation for carbon monoxide. Age (OR = 0.974, p = 0.0086) and diffusion capacity of the lungs for carbon monoxide (per 10% increase in percent-predicted; OR = 0.896, p = 0.0007) was negatively associated with anti-fibrotic use while time (in log of days) since diagnosis (OR = 1.138, p