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Comparing new treatments for idiopathic pulmonary fibrosis - a network meta-analysis

Comparing new treatments for idiopathic pulmonary fibrosis - a network meta-analysis
Comparing new treatments for idiopathic pulmonary fibrosis - a network meta-analysis

BACKGROUND: The treatment landscape for idiopathic pulmonary fibrosis, a devastating lung disease, is changing. To investigate the effectiveness of treatments for idiopathic pulmonary fibrosis we undertook a systematic review, network meta-analysis and indirect comparison.

METHODS: We searched MEDLINE, EMBASE and The Cochrane library for relevant studies. Randomised controlled trials of pirfenidone, nintedanib or N-acetylcysteine were eligible. Predefined processes for selecting references, extracting data and assessing study quality were applied. Our network meta-analysis of published data used a fixed effect model. For forced vital capacity measures a standardised mean difference approach was used and converted to odds ratios for interpretation.

RESULTS: Of 1076 references, 67 were retrieved and 11 studies included. Studies were of reasonable size, populations were similar, and the overall quality was good. Only two treatments, pirfenidone (odds ratio 0.62, 95% credible interval 0.52, 0.74) and nintedanib (0.41, 95% credible interval 0.34, 0.51) produced a statistically significant slowing in the rate of forced vital capacity decline compared with placebo. In an indirect comparison, results indicate that nintedanib is statistically significantly better than pirfenidone in slowing forced vital capacity decline (odds ratio 0.67, 95% credible interval 0.51, 0.88). Results were stable in scenario analysis and random effects models. Indirect comparisons of mortality were not statistically significant between nintedanib and pirfenidone.

CONCLUSIONS: Two treatments show beneficial effects and when compared indirectly nintedanib appears to have superior benefit on forced vital capacity. Limitations to indirect comparisons should be considered when interpreting these results, however, our findings can be useful to inform treatment decisions.

Acetylcysteine/therapeutic use, Anti-Inflammatory Agents, Non-Steroidal/therapeutic use, Enzyme Inhibitors/therapeutic use, Free Radical Scavengers/therapeutic use, Humans, Idiopathic Pulmonary Fibrosis/drug therapy, Indoles/therapeutic use, Pyridones/therapeutic use, Treatment Outcome
1471-2466
2-7
Loveman, Emma
06ff1bf1-0189-4330-b22d-f5a917e9871d
Copley, Vicky R.
32f28acd-1199-4c6e-a08d-3d1a9c11778d
Scott, David A.
19b5fd34-9974-4ae4-8be0-27a693639e20
Colquitt, Jill L.
b5872647-bc73-47d1-be44-8d1170eddbc6
Clegg, Andrew J.
838091f5-39df-4dbe-a369-675b26f2301b
O'Reilly, Katherine M.A.
05c7174f-1231-45d7-b303-a499ebe2e34d
Loveman, Emma
06ff1bf1-0189-4330-b22d-f5a917e9871d
Copley, Vicky R.
32f28acd-1199-4c6e-a08d-3d1a9c11778d
Scott, David A.
19b5fd34-9974-4ae4-8be0-27a693639e20
Colquitt, Jill L.
b5872647-bc73-47d1-be44-8d1170eddbc6
Clegg, Andrew J.
838091f5-39df-4dbe-a369-675b26f2301b
O'Reilly, Katherine M.A.
05c7174f-1231-45d7-b303-a499ebe2e34d

Loveman, Emma, Copley, Vicky R., Scott, David A., Colquitt, Jill L., Clegg, Andrew J. and O'Reilly, Katherine M.A. (2015) Comparing new treatments for idiopathic pulmonary fibrosis - a network meta-analysis. BMC Pulmonary Medicine, 15 (37), 2-7. (doi:10.1186/s12890-015-0034-y).

Record type: Article

Abstract

BACKGROUND: The treatment landscape for idiopathic pulmonary fibrosis, a devastating lung disease, is changing. To investigate the effectiveness of treatments for idiopathic pulmonary fibrosis we undertook a systematic review, network meta-analysis and indirect comparison.

METHODS: We searched MEDLINE, EMBASE and The Cochrane library for relevant studies. Randomised controlled trials of pirfenidone, nintedanib or N-acetylcysteine were eligible. Predefined processes for selecting references, extracting data and assessing study quality were applied. Our network meta-analysis of published data used a fixed effect model. For forced vital capacity measures a standardised mean difference approach was used and converted to odds ratios for interpretation.

RESULTS: Of 1076 references, 67 were retrieved and 11 studies included. Studies were of reasonable size, populations were similar, and the overall quality was good. Only two treatments, pirfenidone (odds ratio 0.62, 95% credible interval 0.52, 0.74) and nintedanib (0.41, 95% credible interval 0.34, 0.51) produced a statistically significant slowing in the rate of forced vital capacity decline compared with placebo. In an indirect comparison, results indicate that nintedanib is statistically significantly better than pirfenidone in slowing forced vital capacity decline (odds ratio 0.67, 95% credible interval 0.51, 0.88). Results were stable in scenario analysis and random effects models. Indirect comparisons of mortality were not statistically significant between nintedanib and pirfenidone.

CONCLUSIONS: Two treatments show beneficial effects and when compared indirectly nintedanib appears to have superior benefit on forced vital capacity. Limitations to indirect comparisons should be considered when interpreting these results, however, our findings can be useful to inform treatment decisions.

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Accepted/In Press date: 7 April 2015
e-pub ahead of print date: 18 April 2015
Published date: 2015
Keywords: Acetylcysteine/therapeutic use, Anti-Inflammatory Agents, Non-Steroidal/therapeutic use, Enzyme Inhibitors/therapeutic use, Free Radical Scavengers/therapeutic use, Humans, Idiopathic Pulmonary Fibrosis/drug therapy, Indoles/therapeutic use, Pyridones/therapeutic use, Treatment Outcome

Identifiers

Local EPrints ID: 442153
URI: http://eprints.soton.ac.uk/id/eprint/442153
ISSN: 1471-2466
PURE UUID: 53b85c7e-7ceb-4363-a87c-b7f31358ec74
ORCID for David A. Scott: ORCID iD orcid.org/0000-0001-6475-8046

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Date deposited: 07 Jul 2020 16:55
Last modified: 08 Jul 2020 00:47

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Contributors

Author: Emma Loveman
Author: Vicky R. Copley
Author: David A. Scott ORCID iD
Author: Jill L. Colquitt
Author: Andrew J. Clegg
Author: Katherine M.A. O'Reilly

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