Concomitant medication burden linked with antifibrotic medication intolerance in IPF

In a new study, concomitant medication burden was associated with antifibrotic medication intolerance in patients with idiopathic pulmonary fibrosis.

“The focus of patient care in interstitial lung disease has centered on ... both disease modification and symptom control,” Yet H. Khor, MBBS, PhD, clinical lecturer and fellow in the department of respiratory and sleep medicine at Austin Health and the Institute for Breathing and Sleep, Heidelberg, Victoria, and the Central Clinical School at Monash University and Faculty of Medicine at the University of Melbourne, Australia, told Healio. “While antifibrotic drugs are effective at slowing disease progression, patients often experience significant drug-related side effects affecting their treatment course. However, these patients often have multiple comorbidities requiring medical attention, which could affect their treatments for interstitial lung disease and health outcomes.”

Researchers identified 645 patients with IPF (mean age, 69 years; 76% men) who received nintedanib (Ofev, Boehringer Ingelheim) or pirfenidone (Esbriet, Genentech) and 1,255 patients with non-IPF ILD (mean age, 59 years; 37% men) who received azathioprine or mycophenolate who participated in two Australian and Canadian registries. Concomitant medication burden at baseline was evaluated based on medication count, polypharmacy (five or more medications) and the Medication Regimen Complexity Index (MRCI). At 6 months and 1 year after ILD-targeted medication initiation, researchers evaluated medication intolerance and discontinuation.

The findings were published in the Annals of the American Thoracic Society.

Forty-three percent of patients with IPF experienced adverse outcomes that led to antifibrotic medication intolerance, which was defined as dose reduction, temporary dose interruption or permanent drug discontinuation within 6 months of initiation.

Moreover, high concomitant medication burden at baseline was consistently associated with medication intolerance for medication count (P = .005), polypharmacy (P = .006) and the MRCI (P = .004).

Researchers observed no association with medication intolerance for immunosuppressive medications among the patients with non-IPF ILD. In these patients, the rate of intolerance was 18%.

At 1 year, the researchers reported no independent association between concomitant medication burden at baseline and permanent discontinuation of antifibrotic (29%) and immunosuppressive (20%) medications.

The MRCI measured the concomitant medication burden associated with transplant-free survival among patients with IPF and patients with non-IPF ILD (P < .01 for both). This measure improved prognostication beyond the common clinical factors and the ILD-GAP index (P < .001), the researchers wrote.

“Medication burden is related to tolerability of antifibrotic drugs and survival in people with interstitial lung disease,” Khor told Healio. “Our findings highlight the importance of holistic care in people with interstitial lung disease. It is now important to study whether reducing medication burden and optimizing management of comorbidities in people with interstitial lung disease would improve tolerability of antifibrotic therapy drugs and health outcomes.”

For more information:

Yet H. Khor, MBBS, PhD, can be reached at yet.khor@monash.edu.