scholarly journals Acute exacerbations in the INPULSIS trials of nintedanib in idiopathic pulmonary fibrosis

2017 ◽  
Vol 49 (5) ◽  
pp. 1601339 ◽  
Author(s):  
Harold R. Collard ◽  
Luca Richeldi ◽  
Dong Soon Kim ◽  
Hiroyuki Taniguchi ◽  
Inga Tschoepe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Acute Exacerbation ◽  
Supplemental Oxygen ◽  
Rank Test ◽  
Risk Of Mortality ◽  
Acute Exacerbations ◽  
The Impact ◽  
Similar Risk

Time to first investigator-reported acute exacerbation was a key secondary end-point in the INPULSIS trials of nintedanib in patients with idiopathic pulmonary fibrosis (IPF).We used the INPULSIS trial data to investigate risk factors for acute exacerbation of IPF and to explore the impact of nintedanib on risk and outcome of investigator-reported and adjudicated confirmed/suspected acute exacerbations. Mortality following these events and events adjudicated as not acute exacerbations was analysed using the log rank test.Risk of acute exacerbations was most strongly associated with the following variables: baseline forced vital capacity (higher risk with lower value), baseline supplemental oxygen (higher risk with use), baseline antacid medication (higher risk with use), treatment (higher risk with placebo), and for confirmed/suspected acute exacerbations, cigarette smoking. Mortality was similar following investigator-reported and adjudicated confirmed/suspected acute exacerbations. Nintedanib had no significant effect on risk of mortality post-exacerbation.Investigator-reported acute exacerbations of IPF are associated with similar risk factors and outcomes as adjudicated confirmed/suspected acute exacerbations.

scholarly journals Initial therapeutic dose of corticosteroid for an acute exacerbation of IPF is associated with subsequent early recurrence of another exacerbation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ryo Yamazaki ◽  
Osamu Nishiyama ◽  
Sho Saeki ◽  
Hiroyuki Sano ◽  
Takashi Iwanaga ◽  
...  
Keyword(s):  
Risk Factors ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Therapeutic Dose ◽  
Early Recurrence ◽  
Time To Recurrence ◽  
Acute Exacerbations ◽  
Patient Groups ◽  
The Mean ◽  
Mean Time

AbstractSome patients with idiopathic pulmonary fibrosis (IPF) undergo recurrent acute exacerbations (AEs). This study aimed to elucidate the risk factors for recurrent AEs of IPF (AE-IPF). Consecutive patients with IPF admitted for their first AE-IPF between January 2008 and December 2018 were retrospectively recruited. Of 63 patients admitted for an AE-IPF and discharged alive, 9 (14.3%) developed a recurrence of AE within 1 year. The mean time to recurrence was 233 ± 103 days. Total doses (mg/month and mg/kg/month) of corticosteroids administered over day 1 to 30 after the AE were significantly higher in patients without recurrences of AE-IPF (5185 ± 2414 mg/month, 93.5 ± 44.0 mg/kg/month) than the doses in patients with recurrences (3133 ± 1990 mg/month, 57.2 ± 37.7 mg/kg/month) (p = 0.02 and p = 0.03, respectively). However, no differences were observed between the total doses of corticosteroids administered over days 31 to 60, 61 to 90, 91 to 120, and 151 to 180 after the AE. Furthermore, differences between the administration rates of immunosuppressive and antifibrotic treatments administered to the 2 patient groups were not significant. An increased total dose of corticosteroid administered over day 1 to 30 after an AE-IPF was associated with a decreased risk of subsequent recurrence of AE-IPF within 1 year after the first AE.

scholarly journals Prevalence, risk factors, and impact of lung cancer on outcomes of idiopathic pulmonary fibrosis: a study from the Middle East

2018 ◽  
Vol 13 ◽  
Author(s):  
Sherif Mohamed ◽  
Hassan Bayoumi ◽  
Nashwa Abd El-Aziz ◽  
Ehab Mousa ◽  
Yasser Gamal
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Odds Ratio ◽  
Independent Predictor ◽  
Significant Independent Predictor ◽  
Upper Egypt ◽  
The Impact

Background: No studies have addressed the impact of lung cancer (LC) on prognosis of patients with idiopathic pulmonary fibrosis (IPF) in Upper Egypt. We aimed to evaluate the prevalence and risk factors for LC among IPF patients and its impact on their outcomes and survival in Upper Egypt. Methods: A total of 246 patients with IPF who had complete clinical and follow up data were reviewed. They were categorized into 2 groups: 34 patients with biopsy-proven LC and IPF (LC-IPF) and 212 patients with IPF only (IPF). Survival and clinical characteristics of the two groups were compared. Results: Prevalence of LC was 13.8%. Pack/years was the most significant predictor for LC development in IPF (Odds ratio; 3.225, CI 1.257–1.669, p = 0.001). Survival in patients with LC-IPF was significantly worse than in patients with IPF without LC; median survival, 35 months vs 55 months; p = 0.000. LC accompanying IPF was one of the most significant independent predictors of survival in IPF patients (Hazard ratio 5.431, CI 2.186–13.492, p = 0.000). Mortality in LC-IPF patients was mainly due to LC progression in 36% and LC therapy-related complications in 22%. Conclusions: Prevalence of LC in IPF patients was 13.8%. Lung cancer has significant impacts on patients with IPF in Upper Egypt, in terms of clinical outcomes and survival. Smoking is the most significant independent predictor of LC development in IPF patients. A poorer survival was observed for patients with IPF developing LC, mainly due to LC progression, and to complications of its therapies. Further prospective, multicenter and larger studies are warranted.

Risk Factors For Acute Exacerbation Of Idiopathic Pulmonary Fibrosis

2010 ◽  
Author(s):  
Yasuhiro Kondoh ◽  
Hiroyuki Taniguchi ◽  
Tomoya Katsuta ◽  
Tomoki Kimura ◽  
Kensuke Kataoka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Acute Exacerbation

scholarly journals Risk factors for an acute exacerbation of idiopathic pulmonary fibrosis

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Tomoyuki Kakugawa ◽  
Noriho Sakamoto ◽  
Shuntaro Sato ◽  
Hirokazu Yura ◽  
Tatsuhiko Harada ◽  
...  
Keyword(s):  
Risk Factors ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Acute Exacerbation

scholarly journals Antifibrotic treatment improves clinical outcomes in patients with idiopathic pulmonary fibrosis: a propensity score matching analysis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Jieun Kang ◽  
Minkyu Han ◽  
Jin Woo Song
Keyword(s):  
Propensity Score ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Propensity Score Matching ◽  
Acute Exacerbation ◽  
Propensity Score Matching Analysis ◽  
Cox Proportional Hazard ◽  
All Cause Mortality ◽  
Related Hospitalisation ◽  
The Impact

Abstract In patients with idiopathic pulmonary fibrosis (IPF), the effects of antifibrotic agents on the prognosis remain unclear. This study aimed to investigate the impact of antifibrotic treatment on the risks of mortality, hospitalisation, and acute exacerbation in real-world patients with IPF. A total of 1213 IPF patients (biopsy-proven cases: 405) were included in this retrospective study. Propensity score matching was used to adjust for differences in baseline characteristics between patients who received antifibrotic treatment and who did not. A Cox proportional hazard model was used to compare the risks of all-cause mortality, hospitalisation, acute exacerbation, and mortality following acute exacerbation between the two groups. From the 1213 patients, 474 matched pairs were generated. The mean age of the patients in the matched cohort was 65.8 years and 82.8% were men. The median follow-up duration was 27 months. Antifibrotic treatment significantly reduced the risks of mortality [hazard ratio (HR), 0.59; 95% confidence interval (CI), 0.48–0.72; p < 0.001], all-cause hospitalisation (HR 0.71), respiratory-related hospitalisation (HR 0.67), acute exacerbation (HR 0.69), and mortality after acute exacerbation (HR 0.60). Our results suggest that antifibrotic treatment may reduce the risks of all-cause mortality, hospitalisation, acute exacerbation, and mortality after acute exacerbation in patients with IPF.

scholarly journals Proteomic characterization of idiopathic pulmonary fibrosis patients: stable versus acute exacerbation

2020 ◽  
Vol 90 (2) ◽  
Author(s):  
Alfonso Carleo ◽  
Claudia Landi ◽  
Antje Prasse ◽  
Laura Bergantini ◽  
Miriana D'Alessandro ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Acute Exacerbation ◽  
Acute Phase Proteins ◽  
Predictive Biomarkers ◽  
Enrichment Analysis ◽  
Lung Carcinogenesis ◽  
Dot Blot ◽  
Acute Exacerbations ◽  
Transduction Signal

Acute exacerbations (AEs) are among the main causes of death in idiopathic pulmonary fibrosis (IPF) patients. In this study proteomic comparative analysis of bronchoalveolar lavage (BAL) fluid samples was performed in stable IPF patients versus AEs IPF group to identify AE pathogenetic mechanisms and novel potential predictive biomarkers. A functional proteomic analysis of BAL fluid samples from stable and AE-IPF patients was conducted in a population of 27 IPF patients. Fifty-one differentially abundant spots were observed and identified by mass spectrometry. Enrichment analysis found proteins of interest involved in the regulation of macrophages and lipid metabolism receptors. In acute exacerbation IPF group, differentially abundant proteins were involved in propagation of the β-catenin WNT transduction signal, and proteins up-regulated in lung carcinogenesis (IGKC, S100A9, PEDF, IGHG1, ALDOA, A1AT, HPT, CO3 and PIGR) and acute phase proteins involved in protease-antiprotease imbalance (such as A1AT fragments). Dot-blot analysis of A1AT C-36 peptide allowed validating our findings, confirming up-regulation in AE IPF patients and suggesting its potential pathogenetic role. A crucial role of protease/antiprotease imbalance, clathrin-mediated endocytosis signalling and carcinogenesis emerged in IPF patients developing acute exacerbations.

scholarly journals Asymmetry in acute exacerbation of idiopathic pulmonary fibrosis

2017 ◽  
Vol 3 (2) ◽  
pp. 00036-2016 ◽  
Author(s):  
Akihiko Sokai ◽  
Kiminobu Tanizawa ◽  
Tomohiro Handa ◽  
Takeshi Kubo ◽  
Seishu Hashimoto ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Acute Exacerbation ◽  
Ground Glass Opacity ◽  
Serum Lactate ◽  
Serum Lactate Dehydrogenase ◽  
High Resolution Computed Tomography ◽  
Disease Extent ◽  
The Impact

Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) results in poor survival. The objective of the present study was to elucidate the impact of asymmetrical ground-glass opacity (GGO) and/or consolidation on outcomes in patients with AE-IPF.The cases of 59 consecutive patients with AE-IPF were retrospectively reviewed. High-resolution computed tomography (HRCT) at diagnosis of an AE was assessed to determine the disease extent and asymmetry. Asymmetrical AE was defined as a right-to-left ratio of GGO and consolidation ≥2.0 or ≤0.5. The impacts of HRCT indices and other clinical parameters on 180-day mortality were analysed.The overall 180-day mortality rate was 59.2%, and asymmetrical AE was observed in 13 patients (22.0%). A multivariate analysis revealed that asymmetrical AE was a significant predictor of 180-day mortality (hazard ratio=0.36, p=0.047), long-term oxygen therapy before AE and serum lactate dehydrogenase levels. The 180-day mortality of patients with asymmetrical AE was significantly lower than that of patients with symmetrical AE (asymmetrical AE 30.8% versus symmetrical AE 68.2%, p=0.03).An asymmetrical distribution of GGO and/or consolidation is a predictor of survival in patients with AE-IPF.

scholarly journals Hospitalizations in patients with idiopathic pulmonary fibrosis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hyun J. Kim ◽  
Laurie D. Snyder ◽  
Ayodeji Adegunsoye ◽  
Megan L. Neely ◽  
Shaun Bender ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Cox Regression ◽  
Ventilatory Support ◽  
Patient Characteristics ◽  
Risk Of Mortality ◽  
Point Increase ◽  
Increased Risk ◽  
The Impact

Abstract Background Hospitalizations are common among patients with idiopathic pulmonary fibrosis (IPF). We investigated the impact of hospitalizations on outcomes in patients with IPF. Methods The IPF-PRO Registry is an observational US registry that enrolled patients with IPF that was diagnosed or confirmed at the enrolling center in the previous 6 months. Associations between patient characteristics and hospitalization, and between hospitalization and mortality, were analyzed using Cox regression models. Results A total of 1002 patients with IPF were enrolled into the IPF-PRO Registry. Over a median follow-up time of 23.7 months (maximum: 67.0 months), 568 patients (56.7%) had at least one hospitalization. Of these patients, 319 (56.2%) had at least one respiratory-related hospitalization and 120 (21.1%) had at least one hospitalization with ventilatory support. Younger age (HR 0.68 [95% CI 0.55, 0.84] per 5-year increase for patients < 62 years), lower BMI (0.96 [0.93, 0.98] per 1-point increase), lower FVC % predicted (0.90 [0.83, 0.97] per 10% increase), oxygen use at rest (2.85 [2.18, 3.72]) and history of pulmonary hypertension (2.02 [1.37, 2.96]) at enrollment were associated with an increased risk of respiratory-related hospitalization during follow-up. In a multivariable model, there was an eightfold increase in the risk of mortality during hospitalization or within 90 days of discharge compared with outside of this period. The risk of mortality associated with a respiratory hospitalization or a hospitalization with ventilatory support was even greater. Conclusions Data from the IPF-PRO Registry demonstrate that hospitalizations are common among patients with IPF. The risk of mortality during hospitalization or within 90 days of discharge was high, particularly among patients who were hospitalized for a respiratory cause or received ventilatory support. Trial registration ClinicalTrials.gov, NCT01915511. Registered 5 August 2013, https://clinicaltrials.gov/ct2/show/NCT01915511

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