Despite the availability of approved antifibrotic treatments for idiopathic pulmonary fibrosis (IPF), many patients in Europe do not receive them, partly due to a lack of awareness by physicians or a preference for a “wait and watch” approach in people with stable or milder disease, a survey reveals.
Better education is needed in Europe to increase “physician awareness of the benefits associated with antifibrotic treatment across the spectrum of IPF severity,” its researchers wrote.
The antifibrotic treatments Esbriet (pirfenidone, marketed by Genentech) and Ofev (nintedanib, marketed by Boehringer Ingelheim) have been shown to significantly reduce the risk of disease progression, and are approved by both the European Medicines Agency and the U.S. Food and Drug Administration for IPF.
In the study “Unmet needs in the treatment of idiopathic pulmonary fibrosis―insights from patient chart review in five European countries,” published in the journal BMC Pulmonary Medicine, researchers in Europe conducted an online physician survey to assess treatment patterns and identify unmet treatment needs across the continent.
The study involved 290 doctors in Germany, France, Italy, the U.K. and Spain, who responded to questions regarding 1,783 IPF patients. Conducted in 2016, the survey asked whether these patients were being treated with antifibrotic drugs — or whether they were not given treatment at all or on unapproved therapies. It also included questions regarding the classification of the disease and its severity.
More patients had a confirmed diagnosis of IPF when diagnosed at expert centres compared to non-expert centers (70.1% vs. 62.4%), suggesting that referral to a non-specialist may affect both diagnosis and access to treatment.
Survey results also found that less than half — 47.7% — of patients were given approved antifibrotic treatment, and that those who did receive treatment were more likely to have a confirmed IPF diagnosis. Still, about 40% of those with a confirmed diagnosis were not receiving treatment, despite the fact these antifibrotic drugs had been available for two years at the time of the survey.
Regarding the link between disease classification and treatment, the survey found that patients with mild IPF were more likely not to receive treatment (71%), compared to those with moderate IPF (41%) and severe IPF (60%).
Overall, these observations led the team to suggest that physicians were adopting a “watch and wait” approach when faced with what they perceived as mild or stable IPF. Researchers suggest that this maybe due to the lack of physician confidence in the evidence regarding available antifibrotic drugs and issues related to treatment access.
“Despite the availability of antifibrotic therapies, many European patients with confirmed IPF do not receive approved antifibrotic treatment. Importantly, there appears to be a reluctance to treat patients with ‘mild’ or ‘stable’ disease, and instead adopt a ‘watch and wait’ approach” the researchers wrote.
The team believes such “a ‘watch and wait’ approach is of particular concern when evidence suggests immediate intervention can improve outcomes for patients with IPF.”
“More education is required to address diagnostic uncertainty, poor understanding of IPF and its treatments, and issues of treatment access,” the team concluded.
In Europe, IPF has an incidence rate that is thought to be between 1.25 and 23.4 cases per 100,000 people.