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. 2019 Jan-Dec:16:1479973119879678.
doi: 10.1177/1479973119879678.

Physician characteristics associated with treatment initiation patterns in idiopathic pulmonary fibrosis

Peter P LaCamera  1 , Susan L Limb  2 , Tmirah Haselkorn  3 , Elizabeth A Morgenthien  2 , John L Stauffer  2 , Mark L Wencel  4
Affiliations

Physician characteristics associated with treatment initiation patterns in idiopathic pulmonary fibrosis

Peter P LaCamera et al. Chron Respir Dis. 2019 Jan-Dec.

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.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: PPL has received personal fees for consulting and advisory boards from Genentech, Inc. TH is a consultant to Genentech, Inc. SLL, JLS, and EAM are employees of Genentech, Inc. MLW has been a speaker for and received compensation from Genentech, Inc.

Figures

Figure 1.
Figure 1.
Geographic distribution of survey respondents by willingness to consider treatment immediately after an IPF diagnosis is established. Shading and hash marks represent states with survey participation by pulmonologists in the immediate and delayed groups, respectively. IPF: idiopathic pulmonary fibrosis.
Figure 2.
Figure 2.
Main practice setting of pulmonologists by willingness to consider treatment immediately after an IPF diagnosis is established. IPF: idiopathic pulmonary fibrosis.
Figure 3.
Figure 3.
Factors considered in treatment decision-making by pulmonologists (N = 168) by willingness to consider treatment immediately after an IPF diagnosis is established. The question was not posed to anyone who responded “no, usually not” to the question “Do you typically consider initiating treatment with either pirfenidone or nintedanib immediately after establishing the diagnosis of IPF?” IPF: idiopathic pulmonary fibrosis; FVC: forced vital capacity; HRCT: high-resolution computed tomography.
Figure 4.
Figure 4.
Decisions regarding initiation of antifibrotic therapy of pulmonologists by willingness to consider treatment immediately after an IPF diagnosis is established. IPF: idiopathic pulmonary fibrosis.
See this image and copyright information in PMC

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