Clinical use of Ibuprofen is associated with slower FEV1 decline in children with cystic fibrosis

Abstract

Rationale: High-dose ibuprofen in a 4-year controlled trial slowed FEV(1) decline in young subjects with cystic fibrosis, but the effectiveness of ibuprofen has not been assessed in a large group of patients treated clinically with this therapy.

Objectives: To assess the effect of ibuprofen therapy on FEV(1) decline in children and adolescents with cystic fibrosis, using observational data from the Cystic Fibrosis Foundation Patient Registry.

Methods: The rate of decline in FEV(1) percent predicted over 2-7 years among patients age 6-17 years with FEV(1) > 60% predicted, and who were treated with ibuprofen (1,365), was compared with patients of similar age and disease severity who were not treated with this therapy (8,960). Multilevel repeated-measures mixed-regression models were used to estimate rates of decline, adjusting for characteristics and therapies that influenced FEV(1) decline. Adverse effects were compared among those treated versus not treated with ibuprofen.

Measurements and main results: FEV(1) declined less rapidly among patients treated with ibuprofen (difference, 0.60% predicted per year; 95% confidence interval, 0.31 to 0.89; P < 0.0001); a 29% reduction in slope based on an average decline of 2.08% predicted per year for patients not treated. Those treated with ibuprofen were more likely to have an episode of gastrointestinal bleeding requiring hospitalization, but the occurrence was rare in both groups (annual incidence, 0.37 vs. 0.14%; relative risk, 2.72; P < 0.001).

Conclusions: Slower rates of FEV(1) decline are seen in children and adolescents with cystic fibrosis who are treated with ibuprofen. The apparent benefits of ibuprofen therapy outweigh the small risk of gastrointestinal bleeding.

Figure 1.

Estimated average change from baseline in FEV₁ percent predicted over a 5-year period of observation for patients treated (1,365) and not treated (8,960) with high-dose ibuprofen. Patients were age 6–17 years with FEV₁ exceeding 60% predicted at baseline. The actual observation period for each patient ranged from 2 to 7 years, and occurred from 1996 to 2002. Data points are the adjusted mean changes in FEV₁ percent predicted (with 95% confidence interval) at each year after baseline, determined from the longitudinal model (Table 3), adjusting for baseline FEV₁ percent predicted, age, and other baseline covariates (not including use of inhaled tobramycin or dornase alfa).