What proportion of patients with Idiopathic pulmonary fibrosis fall outside UK prescribing criteria for anti-fibrotic treatment? A UK specialist centre review

Brereton, Christopher J., Pontoppidan, Katarina, Wallis, Tim, Richeldi, Luca, Jones, Mark G. and Fletcher, Sophie V. (2019) What proportion of patients with Idiopathic pulmonary fibrosis fall outside UK prescribing criteria for anti-fibrotic treatment? A UK specialist centre review. European Respiratory Journal, 54 (Suppl 63), [PA1348]. (doi:10.1183/13993003.congress-2019.PA1348).

Abstract

Background: anti-fibrotic therapies have transformed the care of patients with Idiopathic Pulmonary Fibrosis (IPF). Within the United Kingdom, prescribing criteria set by NICE (National Institute for Health and Care Excellence) restrict anti-fibrotic prescription to patients with an FVC of 50-80% predicted, potentially excluding a significant proportion of patients with IPF from receiving anti-fibrotic treatment.

Aims and objectives: to investigate the proportion of patients with IPF that do not meet UK NICE prescribing criteria for anti-fibrotic treatment.

Methods: this is a retrospective specialist centre cohort study. Consecutive patients with an MDT diagnosis of IPF and a minimum of 12 months follow up were included in the analysis.

Results: 194 patients with IPF were identified. 150 (77%) were male and 120 (62%) were ex-smokers. Mean age at diagnosis was 73 years (SD=8 years). The most common comorbidity was GORD (n=73, 38%) while 36 (19%) had a background of ischaemic heart disease. At diagnosis mean FVC was 75% predicted (SD=20%) and mean TLCO was 47% predicted (SD=16%). 150 patients (77%) were eligible for anti-fibrotic treatment on diagnosis. 29 (15%) patients were not eligible for anti-fibrotics when assessed by NICE criteria, with 20 having an FVC>80% predicted while 9 had an FVC80% have subsequently received anti-fibrotic treatment following FVC decline.

Conclusions: 15% of patients with IPF referred for specialist centre care were ineligible for anti-fibrotic treatment as a consequence of the NICE FVC prescribing criteria.

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