Fatigue Weighs on IPF Patients and Tends to Worsen Over Time, Study Finds

Fatigue can be a significant burden for people with idiopathic pulmonary fibrosis (IPF), and tends to worsen as the disease progresses or, at best, stay “relatively” stable, a study found.

Increasing fatigue was particularly evident among younger patients who were least affected at the study’s start, and among those being treated with Ofev (nintedanib), possibly due to its known side effects like diarrhea, the researchers reported.

The study, “Fatigue in idiopathic pulmonary fibrosis measured by the Fatigue Assessment Scale during antifibrotic treatment,” was published in the European Clinical Respiratory Journal.

Fatigue is one of the most common complaints in patients with IPF, a chronic disease that leads to progressive scarring (fibrosis) of lung tissue. Statistics indicate that up to 70% of patients experience symptoms of fatigue.

It has also been reported as a side effect of Esbriet (pirfenidone), one of the two anti-fibrotic medications currently approved to treat IPF, the other being Ofev.

Although common and known to affect patients’ quality of life, tools to measure it in the context of IPF have not been developed or validated .

Rather, some IPF studies use the Fatigue Assessment Scale (FAS) — a validated 10-item measure of fatigue in people with sarcoidosis, a chronic inflammatory disease that can also affect the lungs.

Investigators in Denmark reported the findings of a study that aimed to document the evolution of fatigue, based on FAS scores, in IPF patients immediately after starting treatment with either Ofev or Esbriet.

Their study enrolled 52 adults with IPF (30 men and 22 women, mean age of 72.4), who started treatment with one of the two anti-fibrotic therapies between April 2017 and January 2018 at a specialty center at Aarhus University Hospital. Most (80%) had been or were active smokers.

All patients were followed for six months after starting treatment. During the study, they were asked to complete the FAS questionnaire at four different time-points: at the study’s start (baseline measure), and again at one, three, and six months after beginning treatment.

Of these 52 people, 25 were treated with Ofev and 27 with Esbriet.

Results showed that more than half (64%) had substantial fatigue (FAS score greater than 22) before starting treatment.

No significant differences in FAS scores were observed between men and women, although a significantly greater number of men reported FAS score above 35, indicating extreme fatigue.

Likewise, no significant differences were found over the study’s six months between patients using either Ofev or Esbriet.

FAS scores increased in both treatment groups over those months, and statistical analyses indicated that these increases were greater in patients treated with Ofev compared with those taking Esbriet.

“This is interesting, since … only pirfenidone [Esbriet] has fatigue registered as a side effect,” the researchers wrote. “A possible explanation for the increased fatigue in this [Ofev] group compared with the pirfenidone group could be diarrhea.”

Additional analyses found patients with lower fatigue levels (FAS scores of less than 22) before starting treatment were more likely to worsen over time, while those with higher initial fatigue levels held “relatively stable.” A similar trend was found in those who were younger.

Changes in fatigue levels were not mirrored by changes in measures of lung health, indicating that “fatigue seems not to be related to the severity of IPF,” the scientists added.

“Our study … shows that patients with IPF suffer from a significant amount of fatigue at baseline, and fatigue is increasing over time independently of the type of antifibrotic treatment,” they concluded.