背景:抗纤维化药物吡非尼酮和尼达尼布已被证明对特发性肺纤维化(IPF)患者有效。然而,由于缺乏替代治疗方案,停用抗纤维化药物是一个主要的临床问题.因此,我们确定了可能有助于预测抗纤维化药物终止的因素.
方法:我们回顾性招募了2009年至2018年间从群马县7家地区核心医院接受抗纤维化药物治疗的280名IPF患者。日本。
结果:四个月时,与延续组相比,吡非尼酮组短期停药组的预后明显更差,尼达尼布组的预后更差.与持续治疗超过4个月的组相比,吡非尼酮停药组在4个月时表现出血清中更低的白蛋白和更高的C反应蛋白(CRP)水平。在多变量分析中,格拉斯哥预后评分(GPS),众所周知,它是癌症预后的预测因子,包括血清CRP和白蛋白水平,预测吡非尼酮组的早期停药和预后,而体重指数(BMI)预测尼达尼布的早期停药。一个高GPS,白蛋白<3.5g/dL和CRP>1.0mg/dL,吡非尼酮组的预后较差。
结论:GPS和BMI是吡非尼酮和尼达尼布短期停药的重要因素,分别。抗纤维化治疗前对GPS和BMI的初步评估可能有助于减少IPF管理的中断。从而导致IPF患者更好的预后结果。
BACKGROUND: The antifibrotic agents pirfenidone and nintedanib have been shown to be effective in patients with idiopathic pulmonary fibrosis (IPF). However, discontinuation of antifibrotic drugs is a major clinical concern because of the lack of alternative treatment options. Therefore, we identified factors that may be useful for predicting the termination of antifibrotic agents.
METHODS: We retrospectively recruited 280 IPF patients treated with antifibrotic drugs between 2009 and 2018 from seven regional core hospitals in Gunma prefecture, Japan.
RESULTS: At four months, the short-term discontinuation group exhibited a significantly worse prognosis in the pirfenidone group and a poorer prognosis in the nintedanib group compared to that in the continuation group. The discontinuation group of pirfenidone at 4 months exhibited lower albumin and higher C-reactive protein (CRP) levels in the sera compared to the group that continued treatment for more than 4 months. In multivariate analysis, the Glasgow prognostic score (GPS), well known as a predictor of cancer prognosis, which comprises serum CRP and albumin levels, predicted early discontinuation and prognosis in the pirfenidone group, whereas the body mass index (BMI) predicted early discontinuation of nintedanib. A high GPS, with both albumin <3.5 g/dL and CRP >1.0 mg/dL, was associated with a poorer prognosis in the pirfenidone group.
CONCLUSIONS: GPS and BMI were significant factors for short-term pirfenidone and nintedanib discontinuation, respectively. Initial evaluation of GPS and BMI prior to antifibrotic therapy may contribute to less interrupted IPF management, thus leading to better prognostic outcomes in patients with IPF.