IPF drug Esbriet lowers risk of irregular heartbeats by nearly 90%, per study
Findings 'noteworthy,' as those taking this med often have worse disease
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Treatment with Esbriet (pirfenidone) reduces the risk of irregular heartbeat by nearly 90% in adults with idiopathic pulmonary fibrosis (IPF), according to a new study.
Use of the approved IPF drug also eased the worsening of atrial arrhythmias — irregular heartbeats originating in the upper chambers of the heart — and of diastolic dysfunction, a condition in which the heart muscle becomes stiff, preventing the ventricles from relaxing and filling properly with blood between heart contractions.
According to the researchers, “this is particularly noteworthy since one might assume that patients with IPF treated with [Esbriet] might have more advanced disease and be more likely to develop atrial arrhythmias.”
Altogether, “these data suggest that the anti‐fibrotic agent [Esbriet] may improve clinical outcomes by preventing the progression” of heart problems in people with IPF, the team wrote.
The study, “Impact of Pirfenidone on Arrhythmic and Clinical Outcomes in Patients With Idiopathic Pulmonary Fibrosis,” was published in the Journal of Cardiovascular Electrophysiology.
PF is characterized by scarring, or fibrosis, of the lungs, which leads to respiratory symptoms such as shortness of breath and cough. In most cases, the exact cause is never determined, and the disease is classified as idiopathic PF.
Irregular heartbeats are common in IPF
Heart arrhythmias are common in people with IPF. These can manifest not only as atrial but also ventricular fibrillation, when the lower heart chambers contract in a very rapid and uncoordinated manner.
In this study, researchers in South Korea and the U.S. sought to determine whether Esbriet, a drug widely approved for use in IPF, could reduce the occurrence of heart arrhythmias in people with the respiratory condition.
For that, the team analyzed data from an IPF patient registry at a pulmonology outpatient clinic in South Korea. Their study assessed 248 individuals with a mean age of 74; about 8 of every 10 patients were men. A total of 106 (41.2%) were treated with Esbriet, at a mean dose of 978.1 mg per day. The other 142 patients did not receive the medication.
Slightly more than one-third of the patients had diabetes, and more than 40% had high blood pressure, the data showed. Other coexisting conditions included coronary heart disease, when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart muscle, and congestive heart failure, when the heart cannot pump enough blood out to the body.
Heart arrhythmias were assessed using 24-hour Holter monitoring, or a wearable device, within three months of starting Esbriet. For those not treated with Esbriet, monitoring was performed within three months of the first diagnosis of IPF or the first visit to the clinic. Patients underwent monitoring a mean of 3.7 times during a mean follow-up of three years
The data showed that those treated with Esbriet had less severe diastolic dysfunction and a lower decrease in lung function, as assessed by forced vital capacity, the maximum amount of air exhaled after a deep breath.
[Esbriet] use to treat IPF was associated with fewer arrhythmic events … compared to patients who did not use [this drug] during long‐term follow‐up.
Additionally, Esbriet treatment was associated with significantly fewer arrhythmic events, including atrial fibrillation (18.9% vs. 35.2%), early, or premature, atrial heartbeat (16% vs. 24.6%), and premature ventricular complexes, extra heartbeats that can make the heart beat out of rhythm (3.8% vs. 9.2%), than no Esbriet treatment.
Further, arrhythmia burden remained stable in those treated with Esbriet, while it increased in untreated patients, according to the team.
A statistical analysis considering multiple variables found that higher body weight and not being treated with Esbriet were independent risk factors for arrhythmic events in IPF patients. Specifically, that risk was 88.6% lower in IPF patients treated with Esbriet.
That finding led the researchers to note that “obesity is associated with a higher incidence of arrhythmic events in patients with IPF.”
Overall, the team found that Esbriet lowered the risk of irregular heartbeats in people with IPF who were taking the drug.
“[Esbriet] use to treat IPF was associated with fewer arrhythmic events and less diastolic dysfunction compared to patients who did not use [this drug] during long‐term follow‐up,” the researchers concluded.
