#ATS2018 – Start of Anti-Fibrotic Therapy in Newly Diagnosed IPF Patients Can Depend on Physician Preference, Survey Finds

Alice Melão, MSc avatar

by Alice Melão, MSc |

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A pulmonologist’s characteristics — such as the nature of the practice and previous treatment experience — can influence when anti-fibrotic therapy use is initiated in newly diagnosed idiopathic pulmonary fibrosis (IPF)  patients, a study based on a U.S. survey found.

This finding adds to an understanding of the factors, besides patient preference, that may influence therapy approaches in managing IPF.

The study, “Physician Characteristics Associated with Treatment Initiation Patterns in Idiopathic Pulmonary Fibrosis: Results from an Online, Self-Administered Survey,” was a poster presentation at the recent American Thoracic Society (ATS) 2018 International Conference in San Diego.

The poster was presented by Peter LaCamera, MD, a critical care pulmonologist specialist at St. Elizabeth’s Medical Center in Boston.

In collaboration with Genentech, the research team conducted an online survey of pulmonologists across the U.S. with experience in direct IPF patient care and anti-fibrotic therapy use. Participants were identified by the Pulmonary Fibrosis Foundation and an external database of physicians.

A total of 169 pulmonologists answered a series of questions addressing their willingness to consider treatment with anti-fibrotic therapy immediately after an IPF diagnosis. The questions covered the timing and reasons for anti-fibrotic therapy, as well as attitudes toward adopting a “watch-and-wait” approach, and the decision-making process.

According to the responses, 81.7% of these physicians said they considered starting anti-fibrotic therapy immediately after IPF diagnosis in all or most cases, while 18.3%  said they were more reluctant to use this class of medications right away.

A detailed analysis of  physician characteristics showed that those reporting to be more likely to prescribe anti-fibrotic therapies were also more likely to work in private practice, and to have more patients already under such therapies.

A sizable number — 31.2% of these physicians — were more likely to make the decision to initiate treatment themselves.

Still, among both groups, the decision to start fibrosis-targeting therapies immediately after diagnosis is mainly based on results of pulmonary function tests, the severity of a patient’s symptoms, a patient’s preference for starting such therapy, and results of high-resolution computed tomography (CT) scans.

A “watch-and-wait” approach was, on average, reported to be used in 32.7% of newly diagnosed IPF cases, mainly due to patient preference, absence of symptoms, and evidence of minimal impairment in pulmonary function.

While these results found that most U.S. pulmonologists do consider initiating anti-fibrotic treatment soon after an IPF diagnosis, their characteristics also influenced their treatment approaches.

“Most pulmonologists consider initiating antifibrotic treatment immediately after establishing an IPF diagnosis all or most of the time, although practice setting, percent of patients receiving IPF therapy, and the decision-making dynamics between patient and physician were distinguishing characteristics for treating immediately vs ‘watch-and-wait’,” the researchers concluded.