Impact of antifibrotic therapy on disease progression, all-cause mortality, and risk of acute exacerbation in non-IPF fibrosing interstitial lung diseases: evidence from a meta-analysis of randomized controlled trials and prospective controlled studies.

IF 4.3 3区材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC

ACS Applied Electronic Materials Pub Date : 2024-01-01 DOI:10.1177/17534666241232561

De-Yu Li, Xin Liu, Jing-Yi Huang, Wen-Lu Hang, Gu-Ran Yu, Yong Xu

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引用次数: 0

Abstract

Background: Nintedanib and pirfenidone are preferred pharmacological therapies for patients with idiopathic pulmonary fibrosis (IPF). However, evidence favoring antifibrotic therapy in patients with non-IPF fibrosing interstitial lung diseases (ILD) is limited.

Objective: To investigate the effects of antifibrotic therapy on disease progression, all-cause mortality, and acute exacerbation (AE) risk in patients with non-IPF fibrosing ILDs.

Design: Meta-analysis.

Data sources and methods: Electronic databases were searched for articles published before 28 February 2023. Studies that evaluated the efficacy of antifibrotic agents in patients with fibrosing ILDs were selected. The primary outcome was the disease progression risk, and the secondary outcomes included all-cause mortality and AE risk. The GRADE criteria were used for the certainty of evidence assessment.

Results: Nine studies with 1990 participants were included. Antifibrotic therapy reduced the rate of patients with disease progression (five trials with 1741 subjects; relative risk (RR), 0.56; 95% CI, 0.42-0.75; p < 0.0001; I² = 0; high-certainty evidence). Antifibrotic therapy did not significantly decrease all-cause mortality (nine trials with 1990 subjects; RR, 0.76; 95% CI, 0.55-1.03; p = 0.08; I² = 0; low-certainty evidence). However, in patients with progressive fibrosing ILDs (PF-ILD), antifibrotic therapy decreased all-cause mortality (four trials with 1100 subjects; RR, 0.69; 95% CI, 0.48-0.98; p = 0.04; I² = 0; low-certainty evidence).

Conclusion: Our study supports the use of antifibrotic agents in patients with PF-ILDs, which could slow disease progression and decrease all-cause mortality.

Trial registration: This study protocol was registered with PROSPERO (registration number: CRD42023411272).

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抗纤维化治疗对非 IPF 纤维性间质性肺病的疾病进展、全因死亡率和急性加重风险的影响：随机对照试验和前瞻性对照研究的荟萃分析证据。

背景：奈替达尼（Nintedanib）和吡非尼酮（pirfenidone）是特发性肺纤维化（IPF）患者的首选药物疗法。然而，在非特发性肺纤维化纤维化间质性肺病（ILD）患者中，支持抗纤维化治疗的证据却很有限：研究抗纤维化治疗对非IPF纤维化间质性肺疾病患者的疾病进展、全因死亡率和急性加重（AE）风险的影响：数据来源和方法：在电子数据库中检索 2023 年 2 月 28 日之前发表的文章。筛选出评估抗纤维化药物对纤维性 ILD 患者疗效的研究。主要结果为疾病进展风险，次要结果包括全因死亡率和AE风险。采用 GRADE 标准对证据的确定性进行评估：结果：共纳入了 9 项研究，参与人数为 1990 人。抗纤维化治疗降低了疾病进展患者的比例（5 项试验，1741 名受试者；相对风险 (RR)，0.56；95% CI，0.42-0.75；p I2 = 0；高确定性证据）。抗纤维化治疗并不能显著降低全因死亡率（9项试验，1990名受试者；RR，0.76；95% CI，0.55-1.03；P = 0.08；I2 = 0；低确定性证据）。然而，在进展性纤维化ILD（PF-ILD）患者中，抗纤维化治疗可降低全因死亡率（4项试验，1100名受试者；RR，0.69；95% CI，0.48-0.98；P = 0.04；I2 = 0；低确定性证据）：我们的研究支持在PF-ILD患者中使用抗纤维化药物，这可以延缓疾病进展并降低全因死亡率：本研究方案已在 PROSPERO 注册（注册号：CRD42023411272）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ACS Applied Electronic Materials Multiple-

CiteScore

7.20

自引率

4.30%

发文量

567