The Impact of Switching to a Second Antifibrotic in Patients With Idiopathic Pulmonary Fibrosis: A Retrospective Multicentre Study From the EMPIRE Registry

Authors	GREGOR Jakub ADIR Yochai STERCLOVA Martina MOGULKOC Nesrin KRAMER Mordechai R DOUBKOVÁ Martina PLACKOVA Martina MULLER Veronika STUDNICKA Michael ZURKOVA Monika LACINA Ladislav LEWANDOWSKA Katarzyna BARTOS Vladimir OVESNÁ Petra MÁJEK Ondřej KOZIAR VASAKOVA Martina
Year of publication	2024
Type	Article in Periodical
Magazine / Source	ARCHIVOS DE BRONCONEUMOLOGIA
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://www.sciencedirect.com/science/article/pii/S0300289623004039?via%3Dihub
Doi	http://dx.doi.org/10.1016/j.arbres.2023.12.002
Keywords	Registries; Antifibrotic agents; Survival; Treatment switch
Description	Introduction: Most patients with idiopathic pulmonary fibrosis (IPF) treated with antifibrotics (AF) have progressive disease despite treatment. A switch of AF may improve survival, but evidence from randomised controlled trials is missing. We aimed to evaluate the efficacy of an AF switch on survival and FVC decline in patients from the European MultiPartner IPF registry (EMPIRE). Methods: The study included 612 patients who discontinued the first antifibrotic therapy. Patients were grouped and analysed from two perspectives: (1) whether they had received a second antifibrotic treatment after the discontinuation of the first therapy, and (2) a reason for discontinuation of the first AF - "lack of efficacy" (LE) and "intolerance" (INT). Results: While 263 (43%) of 612 patients received no second AF ("non-switched"), 349 (57%) patients switched. Overall survival was higher in patients who received a second AF (median 50 vs. 29 months; adjusted HR 0.64, P=0.023). Similarly, the annual FVC decline was significantly reduced in switched patients: -98ml/y in switched and -172ml/y in non-switched patients (P=0.023), respectively. The switched patients had similar risk for mortality in both LE and INT groups (adjusted HR 0.95, P=0.85). The high impact of switching on survival was demonstrated in LE patients (adjusted HR 0.27, P<0.001). Conclusion: The patients without a second AF had significantly shorter overall survival. Our analysis suggests the importance of switching patients with an ineffective first AF therapy to a second AF therapy.