Treatment patterns and patient journey in progressive pulmonary fibrosis: a cross-sectional survey

Abstract

Background: For patients with interstitial lung diseases (ILDs) presenting with a progressive pulmonary fibrosis (PPF) phenotype, current knowledge of disease characteristics at diagnosis, patient journey, and treatment is limited. This study aimed to describe demographics and clinical experiences of patients presenting with PPF in a European real-world setting.

Methods: Data were analysed from the Adelphi Real World PPF-ILD Disease Specific Programme™, a cross-sectional survey of pulmonologists and rheumatologists in five European countries (France, Germany, Italy, Spain, United Kingdom) and internal medicine specialists (France) from April to October 2022. Physicians provided data for up to 12 consecutive patients with physician-confirmed ILD with a progressive phenotype other than idiopathic pulmonary fibrosis. Analyses were descriptive.

Results: Overall, 265 physicians reported on 1,335 patients. Mean (standard deviation) age at survey date was 60.4 (11.6) years, 91.2% were white, 58.1% female, 44.0% non-smokers. Most patients (63.3%) first consulted a primary care physician. There was a mean delay of 7.8 (22.7) months between first ILD symptom and healthcare professional visit, and another 7.7 (12.8) months to ILD diagnosis. At survey date, 47.7% of patients had physician-reported moderate ILD, 42.3% had mild ILD and 10.0% had severe ILD. Disease progression was reported in the 12 months prior to the survey for 19.5% of patients; of these, progression was based on worsening symptom in 27.3% and lung function decline in 25.8%. For patients experiencing symptoms prior to ILD diagnosis (72.8%), the most common symptoms were dyspnoea on exertion (80.5%) and cough (57.8%). Overall, 17.4% of patients were misdiagnosed prior to ILD diagnosis, with chronic obstructive pulmonary disease suspected in 39.2% of them. The most frequent comorbidities were anxiety (16.9%) and gastroesophageal reflux (15.5%). Although 77.8% of patients were receiving treatment for ILD at survey date, 15.6% of patients had never been prescribed treatment for ILD.

Conclusions: This real-world study expands our understanding of patients, diagnostic delays and treatment gaps experienced by patients diagnosed with PPF in Europe. There was a mean delay of 15.5 months between first ILD symptoms and ILD diagnosis. Given the progressive nature of PPF, diagnostic delay may lead to poor outcomes, including shorter survival.

Trial registration: N/a.

Keywords: Antifibrotics; Diagnosis; Interstitial lung disease; Market research; Patient journey; Progressive pulmonary fibrosis; Pulmonary fibrosis; Real-world data; Survey; Treatment patterns.

Fig. 1

Schematic of information collection in the PPF-ILD DSP study. DSP, Disease Specific Programme; ILD, interstitial lung disease; PPF, progressive pulmonary fibrosis

Fig. 2

Physician-rated severity of SSc-ILD according to Goh’s criteria. ILD, interstitial lung disease; SSc, systemic sclerosis; UK, United Kingdom

Fig. 3

Physician-reported reasons for disease progression in the last 12 months. CT, computed tomography; DLco, diffusing capacity of the lungs for carbon monoxide; FVC, forced vital capacity; HRCT, high-resolution CT; ILD, interstitial lung disease

Fig. 4

Patient journey for ILD in Europe. HCP, healthcare professional; ILD, interstitial lung disease; PCP, primary care physician

Fig. 5

Physician-reported patient referral. HCP, healthcare professional; ILD, interstitial lung disease; PCP, primary care physician