Real-World Persistence to Antifibrotic Therapy in Patients with Idiopathic Pulmonary Fibrosis in a Commercial and Medicare Advantage Population
Author(s)
Manisha Lin, PharmD, MPH1, Benjamin S. Wu, MS, PharmD2, Kellie D. Morland, PharmD1, Murali Ramaswamy, MD3;
1United Therapeutics Corporation, Silver Spring, MD, USA, 2United Therapeutics Corporation, HEOR, Ellicott City, MD, USA, 3Moses H. Cone Memorial Hospital, Greensboro, NC, USA
1United Therapeutics Corporation, Silver Spring, MD, USA, 2United Therapeutics Corporation, HEOR, Ellicott City, MD, USA, 3Moses H. Cone Memorial Hospital, Greensboro, NC, USA
Presentation Documents
OBJECTIVES: To characterize adherence and persistence among patients with idiopathic pulmonary fibrosis initiating antifibrotic therapy.
METHODS: A retrospective cohort study was conducted using the Optum’s de-identified Clinformatics® Data Mart Database. Patients with IPF initiating antifibrotic therapy between 01/01/17 through 03/31/24 were identified and indexed on date of first antifibrotic therapy. Patients were required to be aged ≥18 years at index, have ≥1 inpatient or ≥2 outpatient medical claims separated by at least 30 days with a diagnosis of idiopathic pulmonary fibrosis pre-index, continuously enrolled for 6-months pre-index, no claim for antifibrotic therapy pre-index and no prior lung transplant. Adherence to therapy was calculated using proportion of days covered (PDC). Persistence to antifibrotic therapy was quantified in the post-index period and patients with any 45-day gap in therapy were deemed non-persistent. Patients were censored at the earliest date of switching to the other antifibrotic, receiving a lung transplant, death, end of continuous enrollment or end of data.
RESULTS: A total of 2,042 patients met full selection criteria, 743 initiating pirfenidone and 1,299 initiating nintedanib. For all patients, mean(SD) age at initiation was 74.4(8.3), with 38% female and 84% white race. Mean(SD) Quan-Charlson comorbidity index was 3.2 and 29% having co-morbid pulmonary hypertension at treatment initiation. The mean(SD) follow-up time was approximately 19(18) months. Across all available follow-up, the mean PDC was 0.55(0.35) with 37% achieving a PDC ≥0.8 and 55% achieving a PDC ≥0.5. At the end of follow-up, 72% of patients discontinued therapy before meeting a censor criteria and 4% switched to the other antifibrotic. Pirfenidone initiators had slightly higher discontinuations at 74% relative to nintedanib initiators with 70% discontinuing at end of follow-up.
CONCLUSIONS: Patients with IPF have high discontinuation and shortly after initiation of antifibrotic therapy. There remains a large unmet need in the treatment of patients with idiopathic pulmonary fibrosis.
METHODS: A retrospective cohort study was conducted using the Optum’s de-identified Clinformatics® Data Mart Database. Patients with IPF initiating antifibrotic therapy between 01/01/17 through 03/31/24 were identified and indexed on date of first antifibrotic therapy. Patients were required to be aged ≥18 years at index, have ≥1 inpatient or ≥2 outpatient medical claims separated by at least 30 days with a diagnosis of idiopathic pulmonary fibrosis pre-index, continuously enrolled for 6-months pre-index, no claim for antifibrotic therapy pre-index and no prior lung transplant. Adherence to therapy was calculated using proportion of days covered (PDC). Persistence to antifibrotic therapy was quantified in the post-index period and patients with any 45-day gap in therapy were deemed non-persistent. Patients were censored at the earliest date of switching to the other antifibrotic, receiving a lung transplant, death, end of continuous enrollment or end of data.
RESULTS: A total of 2,042 patients met full selection criteria, 743 initiating pirfenidone and 1,299 initiating nintedanib. For all patients, mean(SD) age at initiation was 74.4(8.3), with 38% female and 84% white race. Mean(SD) Quan-Charlson comorbidity index was 3.2 and 29% having co-morbid pulmonary hypertension at treatment initiation. The mean(SD) follow-up time was approximately 19(18) months. Across all available follow-up, the mean PDC was 0.55(0.35) with 37% achieving a PDC ≥0.8 and 55% achieving a PDC ≥0.5. At the end of follow-up, 72% of patients discontinued therapy before meeting a censor criteria and 4% switched to the other antifibrotic. Pirfenidone initiators had slightly higher discontinuations at 74% relative to nintedanib initiators with 70% discontinuing at end of follow-up.
CONCLUSIONS: Patients with IPF have high discontinuation and shortly after initiation of antifibrotic therapy. There remains a large unmet need in the treatment of patients with idiopathic pulmonary fibrosis.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
CO131
Topic
Clinical Outcomes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)