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Effect of nintedanib on acute exacerbations of fibrosing interstitial lung diseases: a national database study in Japan

BACKGROUND: Acute exacerbation is a life-threatening event in patients with fibrosing interstitial lung diseases (ILDs). Although nintedanib reduces acute exacerbation incidence, its effectiveness during acute exacerbation is unclear. METHODS: Using data from the Diagnosis Procedure Combination data...

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Autores principales: Urushiyama, Hirokazu, Jo, Taisuke, Hasegawa, Wakae, Yokoyama, Akira, Ando, Takahiro, Sakamoto, Yukiyo, Kumazawa, Ryosuke, Uda, Kazuaki, Michihata, Nobuaki, Awano, Nobuyasu, Hiroki, Matsui, Fushimi, Kiyohide, Yasunaga, Hideo, Nagase, Takahide
Formato: Online Artículo Texto
Lenguaje:English
Publicado: European Respiratory Society 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9703144/
https://www.ncbi.nlm.nih.gov/pubmed/36451844
http://dx.doi.org/10.1183/23120541.00209-2022
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author Urushiyama, Hirokazu
Jo, Taisuke
Hasegawa, Wakae
Yokoyama, Akira
Ando, Takahiro
Sakamoto, Yukiyo
Kumazawa, Ryosuke
Uda, Kazuaki
Michihata, Nobuaki
Awano, Nobuyasu
Hiroki, Matsui
Fushimi, Kiyohide
Yasunaga, Hideo
Nagase, Takahide
author_facet Urushiyama, Hirokazu
Jo, Taisuke
Hasegawa, Wakae
Yokoyama, Akira
Ando, Takahiro
Sakamoto, Yukiyo
Kumazawa, Ryosuke
Uda, Kazuaki
Michihata, Nobuaki
Awano, Nobuyasu
Hiroki, Matsui
Fushimi, Kiyohide
Yasunaga, Hideo
Nagase, Takahide
author_sort Urushiyama, Hirokazu
collection PubMed
description BACKGROUND: Acute exacerbation is a life-threatening event in patients with fibrosing interstitial lung diseases (ILDs). Although nintedanib reduces acute exacerbation incidence, its effectiveness during acute exacerbation is unclear. METHODS: Using data from the Diagnosis Procedure Combination database (September 2015–March 2020) in Japan, we identified patients with fibrosing ILDs who received intravenous injection of high-dose corticosteroid within 3 days post-admission and analysed their first hospitalisation. We performed overlap propensity score weighting to compare in-hospital outcomes between patients who received nintedanib within 14 days post-admission and those who did not. The primary and secondary outcomes were in-hospital mortality and length of hospitalisation in the patients discharged alive, respectively. RESULTS: Among the 6235 identified patients, 353 patients received nintedanib within 14 days post-admission. In-hospital mortality occurred in 13.7% and 6.0% patients in the control (n=5882) and nintedanib-treated (n=353) patients, respectively. The mean length of hospitalisation was 39.9 and 30.4 days in the control and nintedanib-treated patients, respectively. After overlap propensity score weighting, nintedanib treatment was significantly associated with lower in-hospital mortality in the adjusted cohort (OR 0.43, 95% CI 0.27–0.70; p=0.001). The mean length of hospitalisation in nintedanib-treated patients (30.7 days) was significantly shorter than that in the control group (37.5 days; p<0.001). CONCLUSIONS: Nintedanib initiation during acute exacerbation was significantly associated with a lower risk of in-hospital death and shorter length of hospitalisation in patients with fibrosing ILDs. Our results elucidate the potential role of nintedanib in the treatment of acute exacerbation in patients with fibrosing ILDs. Further prospective studies are warranted.
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spelling pubmed-97031442022-11-29 Effect of nintedanib on acute exacerbations of fibrosing interstitial lung diseases: a national database study in Japan Urushiyama, Hirokazu Jo, Taisuke Hasegawa, Wakae Yokoyama, Akira Ando, Takahiro Sakamoto, Yukiyo Kumazawa, Ryosuke Uda, Kazuaki Michihata, Nobuaki Awano, Nobuyasu Hiroki, Matsui Fushimi, Kiyohide Yasunaga, Hideo Nagase, Takahide ERJ Open Res Original Research Articles BACKGROUND: Acute exacerbation is a life-threatening event in patients with fibrosing interstitial lung diseases (ILDs). Although nintedanib reduces acute exacerbation incidence, its effectiveness during acute exacerbation is unclear. METHODS: Using data from the Diagnosis Procedure Combination database (September 2015–March 2020) in Japan, we identified patients with fibrosing ILDs who received intravenous injection of high-dose corticosteroid within 3 days post-admission and analysed their first hospitalisation. We performed overlap propensity score weighting to compare in-hospital outcomes between patients who received nintedanib within 14 days post-admission and those who did not. The primary and secondary outcomes were in-hospital mortality and length of hospitalisation in the patients discharged alive, respectively. RESULTS: Among the 6235 identified patients, 353 patients received nintedanib within 14 days post-admission. In-hospital mortality occurred in 13.7% and 6.0% patients in the control (n=5882) and nintedanib-treated (n=353) patients, respectively. The mean length of hospitalisation was 39.9 and 30.4 days in the control and nintedanib-treated patients, respectively. After overlap propensity score weighting, nintedanib treatment was significantly associated with lower in-hospital mortality in the adjusted cohort (OR 0.43, 95% CI 0.27–0.70; p=0.001). The mean length of hospitalisation in nintedanib-treated patients (30.7 days) was significantly shorter than that in the control group (37.5 days; p<0.001). CONCLUSIONS: Nintedanib initiation during acute exacerbation was significantly associated with a lower risk of in-hospital death and shorter length of hospitalisation in patients with fibrosing ILDs. Our results elucidate the potential role of nintedanib in the treatment of acute exacerbation in patients with fibrosing ILDs. Further prospective studies are warranted. European Respiratory Society 2022-11-28 /pmc/articles/PMC9703144/ /pubmed/36451844 http://dx.doi.org/10.1183/23120541.00209-2022 Text en Copyright ©The authors 2022 https://creativecommons.org/licenses/by-nc/4.0/This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org (mailto:permissions@ersnet.org)
spellingShingle Original Research Articles
Urushiyama, Hirokazu
Jo, Taisuke
Hasegawa, Wakae
Yokoyama, Akira
Ando, Takahiro
Sakamoto, Yukiyo
Kumazawa, Ryosuke
Uda, Kazuaki
Michihata, Nobuaki
Awano, Nobuyasu
Hiroki, Matsui
Fushimi, Kiyohide
Yasunaga, Hideo
Nagase, Takahide
Effect of nintedanib on acute exacerbations of fibrosing interstitial lung diseases: a national database study in Japan
title Effect of nintedanib on acute exacerbations of fibrosing interstitial lung diseases: a national database study in Japan
title_full Effect of nintedanib on acute exacerbations of fibrosing interstitial lung diseases: a national database study in Japan
title_fullStr Effect of nintedanib on acute exacerbations of fibrosing interstitial lung diseases: a national database study in Japan
title_full_unstemmed Effect of nintedanib on acute exacerbations of fibrosing interstitial lung diseases: a national database study in Japan
title_short Effect of nintedanib on acute exacerbations of fibrosing interstitial lung diseases: a national database study in Japan
title_sort effect of nintedanib on acute exacerbations of fibrosing interstitial lung diseases: a national database study in japan
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9703144/
https://www.ncbi.nlm.nih.gov/pubmed/36451844
http://dx.doi.org/10.1183/23120541.00209-2022
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