Antifibrotic treatment may reduce mortality, acute exacerbations in IPF

In patients with idiopathic pulmonary fibrosis, antifibrotic treatment may reduce the risk for all-cause mortality and acute exacerbations, according to a systematic review and meta-analysis published in Chest.

Tananchai Petnak, MD, principal investigator in the division of pulmonary and pulmonary critical care medicine at Ramathibodi Hospital at Mahidol University in Bangkok, and colleagues conducted a comprehensive search using MEDLINE, Embase, CENTRAL, Cochrane Database of Systematic Reviews and Scopus to identify studies that compared mortality and adverse events in patients with IPF with and without antifibrotic treatment. They identified 26 studies that included 6,425 patients who were treated and 6,531 patients who were not treated. Of the studies, 12 assessed pirfenidone, three assessed nintedanib (Ofev, Boehringer Ingelheim) and 11 did not specify antifibrotic drug type.

The researchers found an association between antifibrotic treatment and decreased risk for all-cause mortality (RR = 0.55; 95% CI, 0.45-0.66), which was consistent across additional subgroup analyses of study type stratification, risk for bias, follow-up duration and antifibrotic subtype. Cohort studies with high bias risk, long-term follow-up, those involving pirfenidone and those with combined or total effects of both antifibrotics demonstrated high heterogeneity (P < .001).

In addition, researchers reported reduced risk for acute exacerbations with antifibrotic treatment (RR = 0.63; 95% CI, 0.53-0.76), which remained consistent across subgroup analyses of randomized controlled trials (RR = 0.58; 95% CI, 0.38-0.89), cohorts (RR = 0.65; 95% CI, 0.63-0.79) and nintedanib subtype (RR = 0.62; 95% CI, 0.43-0.89). An analysis of pirfenidone showed a nonsignificant decrease in risk for acute exacerbations (RR = 0.57; 95% CI, 0.29-1.12).