Physician Characteristics Associated With Treatment Initiation Patterns in Idiopathic Pulmonary Fibrosis

Chron Respir Dis. Jan-Dec 2019;16:1479973119879678. doi: 10.1177/1479973119879678.

Abstract

Pirfenidone and nintedanib are oral antifibrotic agents approved for the treatment of idiopathic pulmonary fibrosis (IPF). Real-world data on factors that influence IPF treatment decisions are limited. Physician characteristics associated with antifibrotic therapy initiation following an IPF diagnosis were examined in a sample of US pulmonologists. An online, self-administered survey was fielded to pulmonologists between April 10, 2017, and May 17, 2017. Pulmonologists were included if they spent >20% of their time in direct patient care and had ≥5 patients with IPF receiving antifibrotics. Participants answered questions regarding timing and reasons for considering the initiation of antifibrotic therapy after an IPF diagnosis. A total of 169 pulmonologists participated. The majority (81.7%) considered initiating antifibrotic therapy immediately after IPF diagnosis all or most of the time (immediate group), while 18.3% considered it only some of the time or not at all (delayed group). Pulmonologists in the immediate group were more likely to work in private practice (26.1%), have a greater mean percentage of patients receiving antifibrotic therapy (60.8%), and decide to initiate treatment themselves (31.2%) versus those in the delayed group (16.1%, 30.5%, and 16.1%, respectively). Most pulmonologists consider initiating antifibrotic treatment immediately after establishing an IPF diagnosis all or most of the time versus using a "watch-and-wait" approach. Distinguishing characteristics between pulmonologists in the immediate group versus the delayed group included practice setting, percentage of patients receiving antifibrotic therapy, and the decision-making dynamics between the patient and the pulmonologist.

Keywords: Antifibrotic therapy; idiopathic pulmonary fibrosis.

MeSH terms

  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / therapeutic use*
  • Clinical Decision-Making
  • Humans
  • Idiopathic Pulmonary Fibrosis / drug therapy*
  • Indoles / administration & dosage
  • Indoles / therapeutic use*
  • Patient Participation
  • Practice Patterns, Physicians'*
  • Private Practice / statistics & numerical data
  • Pulmonary Medicine / statistics & numerical data*
  • Pyridones / administration & dosage
  • Pyridones / therapeutic use*
  • Surveys and Questionnaires
  • Time Factors
  • United States
  • Watchful Waiting / statistics & numerical data

Substances

  • Antineoplastic Agents
  • Indoles
  • Pyridones
  • pirfenidone
  • nintedanib