Background and objective

Idiopathic pulmonary fibrosis (IPF) is a progressive and irreversible interstitial lung disease with poor prognosis despite the recent availability of two antifibrotic drugs. Patients are more susceptible to cardiovascular comorbidities. In this study, we aimed to determine the impact of concomitant cardiovascular drugs on disease progression and survival in a modern IPF cohort.

Methods

The database of a tertiary referral centre for interstitial lung diseases in Belgium was reviewed for statin, antiaggregant, anticoagulant and metformin therapy. For a study period of four years, we noted both FVC% and DLCO% trajectories along with survival as outcome measurements.

Results

323 patients were included of which 45% had at least one cardiovascular comorbidity. 274 (86%) patients received antifibrotic therapy. Statin users (n = 171) displayed significantly slower annual FVC% (difference 2.9%, CI 1.6–4.4, p < 0.001) and DLCO% decline (difference 1.3%, CI 0.24–2.3, p = 0.013). Results for antiaggregant therapy (n = 152) were inconclusive: we found a trend for slower FVC decline (p = 0.098) and a numerically decrease in survival rates (HR 1.63, p = 0.074) in a multivariate Cox analysis. Anticoagulant use (n = 49) showed a trend towards worse DLCO decline (difference −1.3%, CI -2.6 - 0.02, p = 0.055).r Metformin (n = 28) therapy did not affect IPF progression in terms of pulmonary function test evolution or survival.

Conclusion

This retrospective study demonstrated a benefit of statin therapy on IPF progression. Our observations emphasize the need for large clinical trials analysing the effect of statins, as well as other cardiovascular drugs, in the management of IPF patients.

中文翻译：

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他汀类药物：纤维化的原因还是相反？心血管药物对特发性肺纤维化的影响

背景和目的

尽管最近有两种抗纤维化药物可用，但特发性肺纤维化 (IPF) 是一种进行性且不可逆的间质性肺病，预后不佳。患者更易患心血管并发症。在这项研究中，我们旨在确定伴随的心血管药物对现代 IPF 队列中疾病进展和生存的影响。

方法

对比利时间质性肺病三级转诊中心的数据库进行了他汀类药物、抗凝剂、抗凝剂和二甲双胍治疗的审查。在为期四年的研究期间，我们注意到 FVC% 和 DLCO% 轨迹以及生存作为结果测量。

结果

包括 323 名患者，其中 45% 有至少一种心血管合并症。274 (86%) 名患者接受了抗纤维化治疗。他汀类药物使用者（n = 171）的年度 FVC%（差异 2.9%，CI 1.6–4.4，p < 0.001）和 DLCO% 下降（差异 1.3%，CI 0.24–2.3，p = 0.013）显着降低。抗凝剂治疗的结果 (n = 152) 尚无定论：我们在多变量 Cox 分析中发现 FVC 下降较慢 (p = 0.098) 和存活率数值下降的趋势 (HR 1.63，p = 0.074)。抗凝剂使用 (n = 49) 显示出更严重的 DLCO 下降趋势（差异 -1.3%，CI -2.6 - 0.02，p = 0.055）。r 二甲双胍（n = 28）治疗在肺功能测试方面不影响 IPF 进展进化或生存。

结论

这项回顾性研究证明了他汀类药物治疗对 IPF 进展的益处。我们的观察强调需要进行大型临床试验来分析他汀类药物以及其他心血管药物在 IPF 患者管理中的作用。