Woon Hean Chong MD, Dipika Agrawal MD, Ze Ying Tan MD, Sridhar Venkateswaran MD, Adeline Yit Ying Tan MD, Ching Yee Tan MD, Norris Chun Ang Ling MD, Noel Stanley Wey Tut Tay MD
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At respective centers, non-IPF PF-ILD was defined as clinical and radiological findings inconsistent with IPF and greater than 5 % forced vital capacity (FVC) decline, worsening radiological fibrosis or respiratory symptoms.</p></div><div><h3>Results</h3><p>Among seven RCTs involving 1,816 non-IPF PF-ILD patients, anti-fibrotics significantly reduced decline in FVC from baseline in milliliters (MD -66.80milliliters; <em>P</em> < 0.01) and percent predicted (MD -1.80 %; <em>P</em> < 0.01) compared to placebo. However, severity of FVC decline was less than 10 % (<em>P</em> = 0.33) in both groups. No significant difference in the decline of 6MWD from baseline in meters (<em>P</em> = 0.19) while on anti-fibrotics, although those on pirfenidone had less decline in 6MWD (MD -25.12 m; <em>P</em> < 0.01) versus placebo. The rates of all-cause mortality (<em>P</em> = 0.34), all-cause hospitalization (<em>P</em> = 0.44), and hospitalization for respiratory etiology (<em>P</em> = 0.06) were comparable in both groups. Adverse events of nausea/vomiting (54.2 % vs. 20.3 %; <em>P</em> < 0.01), diarrhea (65.2 % vs. 27.6 %; <em>P</em> = 0.02), anorexia/weight loss (23.0 % vs. 7.7 %; <em>P</em> < 0.01), neurological disorders (20.8 % vs. 12.6 %; <em>P</em> < 0.01), and events requiring therapy discontinuation were higher (18.4 % vs. 9.9 %; <em>P</em> < 0.01) in the anti-fibrotic group. Other adverse events of skin (<em>P</em> = 0.18) and respiratory disorders (<em>P</em> = 0.20) were equal.</p></div><div><h3>Conclusion</h3><p>The advent of anti-fibrotics offers alternative treatment to reduce lung function decline.</p></div>","PeriodicalId":55064,"journal":{"name":"Heart & Lung","volume":"68 ","pages":"Pages 242-253"},"PeriodicalIF":2.4000,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A systematic review and meta-analysis of the clinical benefits and adverse reactions of anti-fibrotics in non-IPF progressive fibrosing ILD\",\"authors\":\"Woon Hean Chong MD, Dipika Agrawal MD, Ze Ying Tan MD, Sridhar Venkateswaran MD, Adeline Yit Ying Tan MD, Ching Yee Tan MD, Norris Chun Ang Ling MD, Noel Stanley Wey Tut Tay MD\",\"doi\":\"10.1016/j.hrtlng.2024.07.010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Anti-fibrotics can reduce restrictive impairment in idiopathic pulmonary fibrosis (IPF). However, its effectiveness in non-IPF progressive fibrosing interstitial lung disease (non-IPF PF-ILD) remains uncertain.</p></div><div><h3>Objective</h3><p>We assess the efficacy and safety of anti-fibrotics pirfenidone and nintedanib versus placebo among non-IPF PF-ILD adult patients.</p></div><div><h3>Methods</h3><p>Meta-analysis was performed using PubMed, SCOPUS, and Cochrane databases to identify randomized controlled trials (RCTs). At respective centers, non-IPF PF-ILD was defined as clinical and radiological findings inconsistent with IPF and greater than 5 % forced vital capacity (FVC) decline, worsening radiological fibrosis or respiratory symptoms.</p></div><div><h3>Results</h3><p>Among seven RCTs involving 1,816 non-IPF PF-ILD patients, anti-fibrotics significantly reduced decline in FVC from baseline in milliliters (MD -66.80milliliters; <em>P</em> < 0.01) and percent predicted (MD -1.80 %; <em>P</em> < 0.01) compared to placebo. However, severity of FVC decline was less than 10 % (<em>P</em> = 0.33) in both groups. No significant difference in the decline of 6MWD from baseline in meters (<em>P</em> = 0.19) while on anti-fibrotics, although those on pirfenidone had less decline in 6MWD (MD -25.12 m; <em>P</em> < 0.01) versus placebo. The rates of all-cause mortality (<em>P</em> = 0.34), all-cause hospitalization (<em>P</em> = 0.44), and hospitalization for respiratory etiology (<em>P</em> = 0.06) were comparable in both groups. Adverse events of nausea/vomiting (54.2 % vs. 20.3 %; <em>P</em> < 0.01), diarrhea (65.2 % vs. 27.6 %; <em>P</em> = 0.02), anorexia/weight loss (23.0 % vs. 7.7 %; <em>P</em> < 0.01), neurological disorders (20.8 % vs. 12.6 %; <em>P</em> < 0.01), and events requiring therapy discontinuation were higher (18.4 % vs. 9.9 %; <em>P</em> < 0.01) in the anti-fibrotic group. Other adverse events of skin (<em>P</em> = 0.18) and respiratory disorders (<em>P</em> = 0.20) were equal.</p></div><div><h3>Conclusion</h3><p>The advent of anti-fibrotics offers alternative treatment to reduce lung function decline.</p></div>\",\"PeriodicalId\":55064,\"journal\":{\"name\":\"Heart & Lung\",\"volume\":\"68 \",\"pages\":\"Pages 242-253\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-07-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart & Lung\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0147956324001377\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart & Lung","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0147956324001377","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
A systematic review and meta-analysis of the clinical benefits and adverse reactions of anti-fibrotics in non-IPF progressive fibrosing ILD
Background
Anti-fibrotics can reduce restrictive impairment in idiopathic pulmonary fibrosis (IPF). However, its effectiveness in non-IPF progressive fibrosing interstitial lung disease (non-IPF PF-ILD) remains uncertain.
Objective
We assess the efficacy and safety of anti-fibrotics pirfenidone and nintedanib versus placebo among non-IPF PF-ILD adult patients.
Methods
Meta-analysis was performed using PubMed, SCOPUS, and Cochrane databases to identify randomized controlled trials (RCTs). At respective centers, non-IPF PF-ILD was defined as clinical and radiological findings inconsistent with IPF and greater than 5 % forced vital capacity (FVC) decline, worsening radiological fibrosis or respiratory symptoms.
Results
Among seven RCTs involving 1,816 non-IPF PF-ILD patients, anti-fibrotics significantly reduced decline in FVC from baseline in milliliters (MD -66.80milliliters; P < 0.01) and percent predicted (MD -1.80 %; P < 0.01) compared to placebo. However, severity of FVC decline was less than 10 % (P = 0.33) in both groups. No significant difference in the decline of 6MWD from baseline in meters (P = 0.19) while on anti-fibrotics, although those on pirfenidone had less decline in 6MWD (MD -25.12 m; P < 0.01) versus placebo. The rates of all-cause mortality (P = 0.34), all-cause hospitalization (P = 0.44), and hospitalization for respiratory etiology (P = 0.06) were comparable in both groups. Adverse events of nausea/vomiting (54.2 % vs. 20.3 %; P < 0.01), diarrhea (65.2 % vs. 27.6 %; P = 0.02), anorexia/weight loss (23.0 % vs. 7.7 %; P < 0.01), neurological disorders (20.8 % vs. 12.6 %; P < 0.01), and events requiring therapy discontinuation were higher (18.4 % vs. 9.9 %; P < 0.01) in the anti-fibrotic group. Other adverse events of skin (P = 0.18) and respiratory disorders (P = 0.20) were equal.
Conclusion
The advent of anti-fibrotics offers alternative treatment to reduce lung function decline.
期刊介绍：
Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders.
The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.
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