ArticleTherapeutic advances in respiratory disease
Tocilizumab for the treatment of acute exacerbation of idiopathic pulmonary fibrosis: A matched case-control retrospective study.
Article in Therapeutic advances in respiratory disease. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03666234 (Idiopathic Pulmonary Fibrosis Registry China Study), which is not on this map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Idiopathic Pulmonary Fibrosis Registry China Study
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10 authors.
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Abstract
BackgroundAcute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is a lethal condition with mortality exceeding 50% at 3 months, driven by hyperinflammation. Elevated interleukin-6 (IL-6) is associated with poor outcomes. Tocilizumab (TCZ), an IL-6 receptor antagonist, may modulate this harmful inflammation.ObjectivesTo evaluate the efficacy and safety of tocilizumab combined with corticosteroids in AE-IPF.DesignRetrospective, propensity score-matched, case-control study.MethodsThirty-nine AE-IPF patients from a registry (NCT03666234) were included. Thirteen received tocilizumab (8 mg/kg) plus methylprednisolone, matched 1:2 to 26 receiving conventional therapy. The primary outcome was 3-month all-cause mortality or lung transplantation. Secondary outcomes included changes in ground-glass opacity (GGO) scores and inflammatory biomarkers.ResultsBaseline characteristics were balanced. A GGO score ≥18 predicted higher mortality (HR 5.01, 95% CI 1.47-17.14; p=0.01). In univariable analysis, TCZ was associated with a lower but non-significant risk of the 90-day composite endpoint compared with conventional therapy (unadjusted HR 0.39, 95% CI 0.13-1.18; p=0.095). In an exploratory multivariable Cox model adjusting for baseline GGO score and inflammatory markers, TCZ was associated with a significant risk reduction (adjusted HR 0.20, 95% CI 0.05-0.72; p=0.014). In exploratory subgroup analyses, TCZ was associated with marked risk reductions in high-risk subgroups: GGO score ≥18 (HR 0.07, 95% CI 0.01-0.36; p=0.002), moderate oxygenation impairment (HR 0.12, 95% CI 0.02-1.00; p=0.05), and elevated inflammatory markers (HR 0.26, 95% CI 0.08-0.82; p=0.021). Tocilizumab also reduced GGO scores (p=0.009). Severe infections occurred in 23.1% (3/13) of the tocilizumab group between post-treatment days 12 and 30.ConclusionIn this small, propensity-matched cohort, while the primary unadjusted analysis did not reach statistical significance, multivariable adjustment revealed a significant survival benefit signal associated with TCZ, particularly in patients with extensive ground-glass opacities or hyperinflammation. These findings suggest that TCZ may offer clinical advantages for specific high-risk AE-IPF subgroups, warranting validation in larger prospective trials.
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