scholarly journals Idiopathic Pulmonary Fibrosis in Elderly Patients: Analysis of the INSIGHTS-IPF Observational Study

2020 ◽  
Vol 7 ◽  
Author(s):  
Gabriela Leuschner ◽  
Jens Klotsche ◽  
Michael Kreuter ◽  
Antje Prasse ◽  
Hubert Wirtz ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Elderly Patients ◽  
Age Groups ◽  
Significant Proportion ◽  
Real Life ◽  
The Elderly ◽  
Antifibrotic Therapy ◽  
Significant Difference ◽  
Using Data

Background: An association between idiopathic pulmonary fibrosis (IPF) and advancing age is suspected since IPF occurs primarily in patients over 60 years of age. Though, little is known about the disease in the elderly. The aim of this study was to characterize elderly IPF patients using data from the longitudinal, German-wide INSIGHTS-IPF registry.Methods: Patients were grouped into elderly (≥75 years) and nonelderly IPF (<75 years) at the time of enrollment into the study. Baseline clinical characteristics, comorbidities, health related quality of life (HRQoL), medical therapy and survival were compared between age groups. Effects of antifibrotic therapy on forced vital capacity (FVC) were analyzed over 24 months.Results: Of 1,009 patients, 350 (34.7%) were ≥75 years old. Elderly IPF patients compared to younger patients had a higher number of comorbidities (3.6 ± 2.5 vs. 2.8 ± 2.3; p < 0.001). The mean ± SD EQ-5D score (0.64 ± 0.21 vs. 0.69 ± 0.21; p = 0.005), and the overall WHO-5 score (13.1 ± 5.9 vs. 14.3 ± 6.0; p = 0.015) were significantly lower while the UCSD-SOBQ (52.6 ± 31.2 vs. 45.5 ± 31.2; p = 0.030) was significantly higher in elderly patients, indicating a more impaired HRQoL and more breathlessness. At baseline, 55.4% of elderly and 56.8% of nonelderly patients with IPF were treated with antifibrotic therapy (p = 0.687). For FVC decline after initiation of antifibrotic therapy, there was neither a significant difference between age groups at the different time points over 24 months (beta: 0.41; 95%-CI: −0.98 to 1.81; p = 0.563) nor over the whole course of time (beta: −0.05; 95%-CI: −0.20 to 0.09; p = 0.478). All-cause mortality was higher in elderly patients (49.1 vs. 37.9%; HR 1.65; 95%-CI 1.36–2.00; p < 0.001). Antifibrotic therapy was associated with improved survival in IPF patients, independent from age (<75 years: beta 0.76; 95%-CI: 0.59–0.99; p = 0.049; ≥75 years: beta 0.71; 95%-CI: 0.51–0.98; p = 0.043).Conclusion: In real life, a significant proportion of IPF patients are ≥75 years old, characterized by higher number of comorbidities and global reduced HRQoL. However, the effect of an antifibrotic therapy was similar between age groups and associated with a survival benefit emphasizing the importance for an early antifibrotic therapy in IPF, independent from age.

scholarly journals Differential Discontinuation Profiles between Pirfenidone and Nintedanib in Patients with Idiopathic Pulmonary Fibrosis

Cells ◽  
2022 ◽  
Vol 11 (1) ◽  
pp. 143
Author(s):  
Kazutaka Takehara ◽  
Yasuhiko Koga ◽  
Yoshimasa Hachisu ◽  
Mitsuyoshi Utsugi ◽  
Yuri Sawada ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Adverse Events ◽  
Disease Progression ◽  
Continuous Treatment ◽  
Discontinuation Rate ◽  
Antifibrotic Therapy ◽  
Significant Difference ◽  
One Year ◽  
Observation Period

Antifibrotic agents have been widely used in patients with idiopathic pulmonary fibrosis (IPF). Long-term continuation of antifibrotic therapy is required for IPF treatment to prevent disease progression. However, antifibrotic treatment has considerable adverse events, and the continuation of treatment is uncertain in many cases. Therefore, we examined and compared the continuity of treatment between pirfenidone and nintedanib in patients with IPF. We retrospectively enrolled 261 consecutive IPF patients who received antifibrotic treatment from six core facilities in Gunma Prefecture from 2009 to 2018. Among them, 77 patients were excluded if the antifibrotic agent was switched or if the observation period was less than a year. In this study, 134 patients treated with pirfenidone and 50 treated with nintedanib were analyzed. There was no significant difference in patient background, discontinuation rate of antifibrotic treatment over time, and survival rate between the two groups. However, the discontinuation rate due to adverse events within one year of antifibrotic treatment was significantly higher in the nintedanib group than in the pirfenidone group (76% vs. 37%, p < 0.001). Furthermore, the discontinuation rate due to adverse events in nintedanib was higher than that of pirfenidone treatment throughout the observation period (70.6% vs. 31.2%, p = 0.016). The pirfenidone group tended to be discontinued due to acute exacerbation or transfer to another facility. The results of this study suggest that better management of adverse events with nintedanib leads to more continuous treatment that prevents disease progression and acute exacerbations, thus improving prognosis in patients with IPF.

scholarly journals The Outcomes of Cochlear Implantation in Elderly Patients: A Single United Kingdom Center Experience

2020 ◽  
pp. 014556132091066
Author(s):  
Nikul Amin ◽  
Gentle Wong ◽  
Terry Nunn ◽  
Dan Jiang ◽  
Irumee Pai
Keyword(s):  
United Kingdom ◽  
Health Status ◽  
Speech Perception ◽  
Elderly Patients ◽  
Cochlear Implantation ◽  
Age Groups ◽  
The Elderly ◽  
Glasgow Benefit Inventory ◽  
Significant Difference ◽  
Patient Reported

Objectives: The average life expectancy in the United Kingdom is currently nearly 80 years for a newborn baby with nearly 15% of the population, by 2040, being >75 years old. Hearing impairment is a common disability in the elderly individual, and there have been significant drives to support this population to lead longer and healthier working lives. We aimed to assess the long-term audiological and health-related quality-of-life benefits of cochlear implants (CI) in elderly individuals. Methods: A retrospective and cross-sectional study of patients who received a CI at ≥70 years. Data extracted included speech perception scores, adverse events, telephone use, and patient-reported outcome measures using the Glasgow Benefit Inventory questionnaire with a minimum of 12 months follow-up. Results: Sixty-four patients aged ≥70 years received a unilateral CI. A significant improvement in speech perception scores in all conditions was noted with no significant difference between differing age groups. Glasgow Benefit Inventory scores showed a significant positive impact on patients’ lives and their health status, with no significant difference between the differing age groups. Conclusions: Cochlear implantation is a safe and well-tolerated procedure in the elderly patients with significant improvements observed in audiological performance, health status, and social interactions.

scholarly journals Chemotherapy Treatment of Elderly Patients (≥70 Years) with Non-Small Cell Lung Cancer: A Seven-Year Retrospective Study of Real-Life Clinical Practice at Karolinska University Hospital, Sweden

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Hirsh Koyi ◽  
Gunnar Hillerdal ◽  
Olov Andersson ◽  
Karl-Gustav Kölbeck ◽  
Per Liv ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Practice ◽  
Retrospective Study ◽  
Elderly Patients ◽  
Performance Status ◽  
Age Groups ◽  
Real Life ◽  
The Elderly ◽  
University Hospital ◽  
Nsclc Patients

An increasing proportion of cancer patients are aged >65 years and many are aged >70 years. Treatment of the elderly with lung cancer has, therefore, become an important issue; so we performed a retrospective study of our patients to demonstrate how elderly patients with NSCLC are treated in real-life, clinical practice. All patients aged ≥70 years with NSCLC at our department were reviewed retrospectively. In total, 1059 patients (50.8% of all NSCLC patients). Of these patients, 243 (22.9%) received chemotherapy, 164 (70.4%) of whom were treated with a platinum doublet using carboplatin. Second- and third-line chemotherapy were given to 31.4% and 13.9% of patients, respectively. Median overall survival was 289 and 320 days for male and female patients, respectively. Patients with performance status (PS) 0 experienced significantly better survival than patients with PS1 or PS 2: 410, 314, and 204 days, respectively. Age was of less importance, with patients aged 70–79 years versus those aged ≥80 years. Treatment of elderly NSCLC patients with chemotherapy is feasible if they have a good PS and appears to prolong survival. In this study, we found no significant differences in survival either between age groups or genders.

scholarly journals Angioplasty Outcomes in the Elderly Nepalese Patients: an eight years experience in Norvic International Hospital

2013 ◽  
Vol 8 (1) ◽  
pp. 27-29
Author(s):  
G Chirag ◽  
B Rawat ◽  
S Rajbhandari ◽  
Y Bhatta ◽  
JP Jaiswal ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Age Groups ◽  
The Elderly ◽  
Percutaneous Transluminal Coronary Angioplasty ◽  
Hospital Death ◽  
Interventional Treatment ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Male Patients ◽  
Transluminal Coronary Angioplasty

Background The aim of the study is to evaluate and compare the outcomes of percutaneous transluminal coronary angioplasty (PTCA) between the elderly (>70 yrs) and the non-elderly (70 yrs and younger) Nepalese patients who had been admitted to Norvic International Hospital between early 2002 and April 2010. Methods Data of a total of 92 elderly and 604 non-elderly patients were retrospectively analyzed after they had been admitted in the Hospital for the interventional treatment of acute coronary syndrome. Results There were 64 (69.6%) male patients and 28 (30.4%) female patients in the elderly group. Elderly population had lesser smokers. Diabetic population was similar in both the age groups. The elderly patients slightly less success rate compared to the non-elderly (95.7% vs. 99.3%). There was no significant difference in bleeding complication and groin haematoma. In hospital death was 3.33% in elderly and 0.5% in non elderly. Conclusion Though the outcome in the elderly is poorer in comparison to the younger patients, it is an expected result when compared to even the biggest centres worldwide. DOI: http://dx.doi.org/10.3126/njh.v8i1.8334 Nepalese Heart Journal Vol.8(1) 2011 pp.27-29

scholarly journals Elderly Patients with Metastatic Neuroendocrine Tumors Are Undertreated and Have Shorter Survival: The LyREMeNET Study

2019 ◽  
Vol 110 (7-8) ◽  
pp. 653-661 ◽  
Author(s):  
Annie Lemelin ◽  
Delphine Maucort-Boulch ◽  
Elisabeth Castel-Kremer ◽  
Julien Forestier ◽  
Valérie Hervieu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Neuroendocrine Tumors ◽  
Real Life ◽  
Peptide Receptor Radionuclide Therapy ◽  
Tumor Grade ◽  
The Elderly ◽  
Younger Patients ◽  
Poorly Differentiated Neuroendocrine Carcinoma ◽  
Significant Difference

Introduction: The incidence of neuroendocrine tumors (NETs) is rising, especially in elderly patients. The elderly cancer population presents considerable challenges, yet little is known about the characteristics, treatment patterns, and outcomes of metastatic NET (mNET) patients. Methods: The Lyon Real-life Evidence in Metastatic NeuroEndocrine Tumors study (LyREMeNET, NCT03863106) included consecutive mNET patients, diagnosed between January 1990 and December 2017. The exclusion criteria were nonmetastatic NET, poorly differentiated neuroendocrine carcinoma, and mixed neuroendocrine-nonneuroendocrine neoplasms. We aimed to compare patients ≥70 years old to patients <70 years old. Results: A total of 866 patients were included, 198 (23%) were ≥70 years old. There was no significant difference in characteristics except that elderly patients had synchronous metastasis more frequently. Elderly patients received significantly fewer treatments (median of 2.0 vs. 3.0 lines, respectively, p < 0.0001), were significantly less frequently treated by chemotherapy (32 vs. 54%), targeted therapy (16 vs. 30%), peptide receptor radionuclide therapy (5 vs. 16%), and they underwent significantly less frequently locoregional intervention. Median overall survival was significantly shorter in elderly patients (5.2 vs. 9.6 years). The most frequent cause of death was related to disease progression (71%). Multivariate analysis found that, after adjustment for tumor location, tumor grade, and number of metastatic sites, age remained significantly associated with overall survival (HR 1.66, 95% CI 1.26–2.18), indicating a poorer survival in patients ≥70 years old in comparison with younger patients (p = 0.0003). Conclusion: Patients ≥70 years old have a worse survival, die frequently from their disease, and are undertreated compared to younger patients.

Survival and course of lung function in the presence or absence of antifibrotic treatment in patients with idiopathic pulmonary fibrosis: long-term results of the INSIGHTS-IPF registry

2020 ◽  
Vol 56 (2) ◽  
pp. 1902279 ◽  
Author(s):  
Jürgen Behr ◽  
Antje Prasse ◽  
Hubert Wirtz ◽  
Dirk Koschel ◽  
David Pittrow ◽  
...  
Keyword(s):  
Lung Function ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Survival Rates ◽  
Multivariable Analysis ◽  
Real Life ◽  
Long Term Results ◽  
Antifibrotic Therapy ◽  
Risk Of Death ◽  
The Mean

ObjectiveThere is a paucity of observational data on antifibrotic therapy for idiopathic pulmonary fibrosis (IPF). We aimed to assess the course of disease of IPF patients with and without antifibrotic therapy under real-life conditions.MethodsWe analysed data from a non-interventional, prospective cohort study of consecutively enrolled IPF patients from 20 interstitial lung disease expert centres in Germany. Data quality was ensured by automated plausibility checks, on-site monitoring, and source data verification. Propensity scores were applied to account for known differences in baseline characteristics between patients with and without antifibrotic therapy.ResultsAmong the 588 patients suitable for analysis, the mean±sd age was 69.8±9.1 years, and 81.0% were male. The mean±sd duration of disease since diagnosis was 1.8±3.4 years. The mean±sd value at baseline for forced vital capacity (FVC) and diffusion capacity (DLCO) were 68.6±18.8% predicted and 37.8±18.5% predicted, respectively. During a mean±sd follow-up of 1.2±0.7 years, 194 (33.0%) patients died. The 1-year and 2-year survival rates were 87% versus 46% and 62% versus 21%, respectively, for patients with versus without antifibrotic therapy. The risk of death was 37% lower in patients with antifibrotic therapy (hazard ratio 0.63, 95% CI 0.45; 0.87; p=0.005). The results were robust (and remained statistically significant) on multivariable analysis. Overall decline of FVC and DLCO was slow and did not differ significantly between patients with or without antifibrotic therapy.ConclusionsSurvival was significantly higher in IPF patients with antifibrotic therapy, but the course of lung function parameters was similar in patients with and without antifibrotic therapy. This suggests that in clinical practice, premature mortality of IPF patients eventually occurs despite stable measurements for FVC and DLCO.

scholarly journals Improvement in Subjective Symptoms and Tolerability in Response to Nintedanib Treatment in Elderly Patients with Idiopathic Pulmonary Fibrosis

2020 ◽  
Vol 9 (3) ◽  
pp. 755 ◽  
Author(s):  
Takayuki Takeda ◽  
Yusuke Kunimatsu ◽  
Nozomi Tani ◽  
Izumi Hashimoto ◽  
Yuri Kurono ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Elderly Patients ◽  
The Elderly ◽  
Subjective Assessment ◽  
Phase Iii ◽  
Disease Assessment ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Phase Iii Trials

The efficacy of nintedanib treatment in patients with idiopathic pulmonary fibrosis (IPF) was demonstrated in phase III trials. However, there is limited data on the significance of nintedanib in elderly patients aged ≥75 years. We have retrospectively evaluated 54 newly nintedanib-treated patients including 32 elderly individuals. Potential changes in modified medical research council (mMRC) grade and COPD (chronic obstructive pulmonary disease) assessment test (CAT) score, as well as in forced vital capacity (FVC) were obtained 6 months before, at the time of, and 6 and 12 months after initiation of nintedanib treatment. Significant differences were observed in CAT scores between 6 months before treatment and baseline (p < 0.001), and between baseline and 6 months (p < 0.001) and 12 months (p < 0.001) after treatment. If subjective improvement is defined as an improvement in mMRC grade or CAT score by 1 or 3 points, respectively, 25 patients (46.3%) have significantly improved after 6 months of treatment. Out of these, all have improved in CAT score. The tolerability of nintedanib was similar in elderly and younger patients. These findings suggest that CAT scores could be useful in the subjective assessment during nintedanib treatment, and that nintedanib is safe and efficient for the treatment of the elderly population.

Statins and Elderly: From Clinical Trials to Daily Practice

2019 ◽  
Vol 17 (3) ◽  
pp. 233-238
Author(s):  
Monica Verdoia ◽  
Gennaro Galasso ◽  
Pasquale Perrone Filardi ◽  
Giuseppe De Luca
Keyword(s):  
Clinical Trials ◽  
High Risk ◽  
Elderly Patients ◽  
Age Groups ◽  
Real Life ◽  
Cardiovascular Prevention ◽  
Daily Practice ◽  
The Elderly ◽  
Clinical Complexity ◽  
Risk Patients

Elderly patients represent a rising social problem, due to the exponential growth of persons in these age groups and their atherothrombotic burden. The management of this population still raises several challenges, requiring a balance between elevated cardiovascular risk, clinical complexity, frailty and co-morbidities. </P><P> Statins represent the main pillar in cardiovascular prevention, lowering serum cholesterol and reducing mortality and ischemic events, especially in high-risk patients. Yet, elderly patients have often been excluded from major clinical trials of statins, thus limiting the experience with these drugs in advanced age. Moreover, important barriers to the use of statins in the elderly exist due to potential risks attributed to altered metabolism, comorbidities, polypharmacy and drug-drug interactions and financial constraints. This situation has led to a “statin paradox”, since high-risk elderly patients, that would most benefit from the use of statins, may be undertreated with these drugs in real life. </P><P> The vague indications provided by guidelines mean that this issue is still debated, especially regarding primary prevention. Nevertheless, the benefits in outcome offered by statins cannot be neglected. Efforts should be made in order to focus on the importance of statin use in the elderly and to provide clinicians with adequate tools for case by case decisions.

Efficacy of switching antifibrotic therapy in idiopathic pulmonary fibrosis: real life data

2019 ◽  
Author(s):  
Ivonne M. Raats- ten Cate ◽  
Coline H M Van Moorsel ◽  
Akke-Nynke Van Der Meer ◽  
Pieter Zanen ◽  
Jan C Grutters
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Real Life ◽  
Antifibrotic Therapy ◽  
Life Data ◽  
Real Life Data
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