Which factors predict early discontinuation of antifibrotics in idiopathic pulmonary fibrosis?

Bhomra, Parminder Singh (2020). Which factors predict early discontinuation of antifibrotics in idiopathic pulmonary fibrosis? University of Birmingham. M.Sc.

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Abstract

Introduction: Pirfenidone and nintedanib are recommended in idiopathic pulmonary fibrosis (IPF). Randomised controlled trials have shown discontinuation rates of 14-33%; clinical audit in our regional centre showed a rate of 18.4%. I aimed to establish the main factors, which predict early discontinuation of antifibrotics using a mixed methodology approach.

Methods: I collected data on 170 patients with IPF (2012-16) prescribed pirfenidone (n=139) or nintedanib (n=31). Retrospective data was collected including demographics, social factors, diagnostics, antifibrotic prescribed, treatment duration and side-effects. We undertook focus groups and patient interviews, which were analysed thematically.

Results: Commonest side-effects were nausea/vomiting (50%) and appetite loss (40%; pirfenidone) and diarrhoea (79%) and weight loss (25%; nintedanib). DLCO ≤40% (OR=2.46) increased risk of early discontinuation at 30-days, with males (OR=0.41) and skin side-effects (OR=0.09) associated with reduced risk. At 90-days, deconditioning side effects (OR=2.58) increased risk of early discontinuation, whereas males (OR=0.39) and gastrointestinal side effects (OR=0.40) reduced risk. Thematic analysis suggested side-effects were tolerable and social factors were not considered barriers by patients.

Conclusion: Female gender and DLCO ≤40% were predictors of early discontinuation, compared with social factors. Low DLCO has been shown to predict increased mortality therefore progressive disease would increase risk of early discontinuation.

Type of Work:

Thesis (Masters by Research > M.Sc.)

Award Type:

Masters by Research > M.Sc.

Supervisor(s):