OBJECTIVES

Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease with a high mortality rate. Prior to the introduction of the anti-fibrotic medications pirfenidone and nintedanib, there were no effective treatment options for IPF. Until recently, there were no studies of the real-world effectiveness of these two medications. The purpose of our study is to compare mortality both during and following a respiratory-related hospitalization in patients with IPF who were treated or untreated with an anti-fibrotic medication.

METHODS

We performed a retrospective analysis using the OptumLabs Data Warehouse. We identified patients with IPF who had at least one respiratory-related hospitalization between 2015 and 2018. Patients with an anti-fibrotic medication fill within 45 days prior to their initial hospitalization were considered treated. We created a matched cohort using one-to-one propensity score matching without replacement to account for selection bias. Matching variables included baseline demographic variables, 12 baseline comorbidities, Elixhauser comorbidity index, smoking status, oxygen, steroid use, and year of hospitalization. We fit a Cox proportional hazards model to compare the mortality rates between treated and untreated patients.

RESULTS

Among 3,614 patients with IPF who had a respiratory-related hospitalization, 443 (12.3%) had an anti-fibrotic medication fill in their baseline. More than 50% of the patients were over 75 years old, male, White, smoked, used oxygen in the hospital, and had chronic obstructive pulmonary disease, and hypertension. A total of 443 matched pairs were included in the matched cohort analysis; mean(SD) of follow-up was 21.1(24.4) months. Treatment was associated with a lower risk of all-cause mortality 49 vs 59 events per 100 person-years (hazard ratio: 0.77, 95% confidence interval: 0.61 to 0.98, p< 0.05).

CONCLUSIONS

Anti-fibrotic medications significantly improved mortality both in and after a respiratory-related hospitalization in patients with IPF. Future research is needed to determine if the benefit of these medications outweigh their costs.