A systematic review and meta-analysis of the clinical benefits and adverse reactions of anti-fibrotics in non-IPF progressive fibrosing ILD

被引:0
作者
Chong, Woon Hean [1 ]
Agrawal, Dipika [1 ]
Tan, Ze Ying [1 ]
Venkateswaran, Sridhar [1 ]
Tan, Adeline Yit Ying [1 ]
Tan, Ching Yee [1 ]
Ling, Norris Chun Ang [1 ]
Tay, Noel Stanley Wey Tut [1 ]
机构
[1] Natl Univ Hlth Syst, Ng Teng Fong Gen Hosp, Dept Resp Med, 1 Jurong East St 21, Singapore 609606, Singapore
来源
HEART & LUNG | 2024年 / 68卷
关键词
Anti-fibrotic; Pirfenidone; Nintedanib; ILD; Non-IPF; IDIOPATHIC PULMONARY-FIBROSIS; INTERSTITIAL LUNG-DISEASE; DOUBLE-BLIND; PIRFENIDONE; EFFICACY; NINTEDANIB; SAFETY; DIAGNOSIS; ARTHRITIS;
D O I
10.1016/j.hrtlng.2024.07.010
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:242 / 253
页数:12
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