Abstract
In patients with chronic fibrosing interstitial lung disease (ILD), a progressive fibrosing phenotype (PF-ILD) may develop, but information on the frequency and characteristics of this population outside clinical trials is lacking.
We assessed the characteristics and outcomes of patients with PF-ILD other than idiopathic pulmonary fibrosis (IPF) in a real-world, single-centre clinical cohort. The files of all consecutive adult patients with fibrosing ILD (2010–2017) were examined retrospectively for pre-defined criteria of ≥10% fibrosis on high-resolution computed tomography and progressive disease during overlapping windows of 2 years. Baseline was defined as the date disease progression was identified. Patients receiving nintedanib or pirfenidone were censored from survival and progression analyses.
In total, 1395 patients were screened; 617 had ILD other than IPF or combined pulmonary fibrosis and emphysema, and 168 had progressive fibrosing phenotypes. In 165 evaluable patients, median age was 61 years; 57% were female. Baseline mean forced vital capacity (FVC) was 74±22% predicted. Median duration of follow-up was 46.2 months. Annualised FVC decline during the first year was estimated at 136±328 mL using a linear mixed model. Overall survival was 83% at 3 years and 72% at 5 years. Using multivariate Cox regression analysis, mortality was significantly associated with relative FVC decline ≥10% in the previous 24 months (p<0.05), age ≥50 years (p<0.01) and diagnosis subgroup (p<0.01).
In this cohort of patients with PF-ILD not receiving antifibrotic therapy, the disease followed a course characterised by continued decline in lung function, which predicted mortality.
Abstract
In a real-world clinical cohort (PROGRESS), progressive fibrosing interstitial lung disease was characterised by continued lung function decline. Lung function decline, age and underlying diagnosis subgroup predicted mortality. https://bit.ly/2EB3OpF
Footnotes
This article has supplementary material available from erj.ersjournals.com
This study is registered with ClinicalTrials.gov number NCT03858842.
Conflict of interest: M. Nasser received sponsorship for conference attendance from Boehringer Ingelheim and Hoffmann-La Roche, and received consultation fees from Boehringer Ingelheim.
Conflict of interest: S. Larrieu has nothing to disclose.
Conflict of interest: S. Si-Mohamed has nothing to disclose.
Conflict of interest: K. Ahmad reports relationships and activities from Roche and Boehringer Ingelheim, outside the submitted work.
Conflict of interest: L. Boussel has nothing to disclose.
Conflict of interest: M. Brevet has nothing to disclose.
Conflict of interest: L. Chalabreysse has nothing to disclose.
Conflict of interest: C. Fabre has nothing to disclose.
Conflict of interest: S. Marque has nothing to disclose.
Conflict of interest: D. Revel declares provision of scientific expertise under contract with IQVIA.
Conflict of interest: F. Thivolet-Bejui has nothing to disclose.
Conflict of interest: J. Traclet reports sponsorship for meeting attendance from Roche and Boehringer Ingelheim, outside the submitted work.
Conflict of interest: S. Zeghmar has nothing to disclose.
Conflict of interest: D. Maucort-Boulch has nothing to disclose.
Conflict of interest: V. Cottin reports personal fees for advisory board work and lectures, and non-financial support for meeting attendance from Actelion, grants, personal fees for consultancy and lectures, and non-financial support for meeting attendance from Boehringer Ingelheim and Roche, personal fees for advisory board and data monitoring committee work from Bayer/MSD, personal fees for advisory board work and lectures from Novartis, personal fees for lectures from Sanofi, personal fees for data monitoring and steering committee work from Promedior, personal fees for data monitoring committee work from Celgene and Galecto, and personal fees for advisory board and data monitoring committee work from Galapagos, outside the submitted work.
Support statement: The PROGRESS trial was funded by an unrestricted grant from Boehringer Ingelheim International GmbH (BI) to Hospices Civils de Lyon. IQVIA received financial support from Boehringer Ingelheim Santé Humaine France for the design, monitoring, data-management and statistical analysis of the study. Medical writing, editorial support and formatting assistance were provided by Helen Keyworth of Nucleus Global, which was contracted and funded by BI. The authors did not receive payment for the development of the manuscript. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received March 18, 2020.
- Accepted August 24, 2020.
- Copyright ©ERS 2021
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