Real-world treatment persistence and predictive factors for discontinuation of antifibrotic therapies in patients with idiopathic pulmonary fibrosis: a

Background: Persistence with antifibrotic medications in patients with idiopathic pulmonary fibrosis (IPF) is crucial for long-term outcomes. However, real-world data regarding treatment persistence patterns in IPF are scarce. Methods: We conducted a Results: Overall, 808 patients were included in the analysis. Of these, 278 subjects (34.4%) discontinued therapy over a median follow-up of 16 (8-24) months. The proportion of patients discontinuing therapy was comparable between pirfenidone and nintedanib (37.5% vs. 32.5% respectively; p = 0.15). Additionally, no statistical difference was observed between antifibrotic agents in the distribution of time until treatment discontinuation (log-rank test, p = 0.3). Predictive factors associated with the probability of treatment discontinuation included age (hazard ratio [HR] 1.04; 95% confidence interval [CI] 1.02-1.05), body mass index (BMI, HR 0.97; 95% CI 0.94-0.99), transfer factor of the lung for carbon monoxide (TLco)% predicted (HR 0.98, 95% CI 0.97-0.99), Gender-Age-Physiology (GAP) index score (HR 1.3, 95% CI 1.18-1.42), use of long-term oxygen therapy (LTOT) (HR = 1.7, 95% CI 1.28-2.27) and intermittent dosing adjustment (HR 1.66, 95% CI 1.29-2.15). Conclusion: In this large population-based cohort of patients with IPF, around one-third discontinued antifibrotics during a study follow-up with no difference in the rates and time to discontinuation between pirfenidone and nintedanib. Clinical predictive factors including age, BMI, TLco% predicted, GAP index score, use of LTOT and intermittent dosing adjustment were associated with the risk of treatment discontinuation.