Predictors of the clinical effects of pirfenidone on idiopathic pulmonary fibrosis
Predictors of the clinical effects of pirfenidone on idiopathic pulmonary fibrosis
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DOI：
10.1016/j.resinv.2013.09.002
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发表时间：
2014-03-01
影响因子：
3.1
通讯作者：
Hayashi, Seiji
中科院分区：
文献类型：
--
作者：
Arai, Toru;Inoue, Yoshikazu;Hayashi, Seiji
背景：特发性肺纤维化（IPF）是一种进展性间质性肺疾病，预后不良。最近，据报道吡非尼酮可以减缓肺活量下降的速度并改善 IPF 的无进展生存期。本研究的目的是阐明预测吡非尼酮良好反应的因素及其不良反应。方法：本次调查纳入了2009年1月至2011年1月期间接受吡非尼酮治疗的41例IPF病例。根据日本呼吸学会 (JRS) 的定义，疾病严重程度分为 I-IV 级。通过 JRS 的修改标准评估吡非尼酮的短期反应性。通过多变量 Cox 比例风险分析来检查代表重要不良反应的恶心、厌食或两者的预测因子。通过多变量逻辑回归分析来检查短期反应性的预测因素。结果：通过外科肺活检（SLB）诊断，I/II 级的轻度病例是良好的短期反应性的预测因素。服用酸分泌抑制剂（包括质子泵抑制剂和组胺 H2 受体拮抗剂）的患者表现出较少的厌食、恶心或两者兼而有之。只有1例患者接受了激活胃肠动力的药物。结论：我们得出的结论是，病情较轻、经SLB诊断或两者均显示出对吡非尼酮有良好反应的迹象的IPF患者。此外，酸分泌抑制剂可以减少吡非尼酮引起的厌食、恶心或两者的发生频率。 (C) 2013 年日本呼吸学会。由 Elsevier B.V. 出版。保留所有权利。
Background: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease with a poor prognosis. Recently, pirfenidone was reported to slow the rate of decline in vital capacity and improve progression-free survival in IPF. The purpose of this study was to clarify the factors that predicted a good response to pirfenidone, as well as its adverse effects.Methods: Forty-one IPF cases, treated with pirfenidone from January 2009 to January 2011, were enrolled in this investigation. Disease severity was classified into grades I-IV, as defined by the Japanese Respiratory Society (JRS). Short-term responsiveness to pirfenidone was evaluated by the modified criteria of the JRS. Predictors of nausea, anorexia, or both that represented important adverse effects were examined by multivariate Cox proportional hazard analyses. Predictors of short-time responsiveness were examined by multivariate logistic regression analyses.Results: Diagnosed by a surgical lung biopsy (SLB), the mild cases of grade I/II were predictors of good, short-term responsiveness. Patients taking acid-secretion inhibitors, including proton pump inhibitors and histamine H2-receptor antagonists, showed less anorexia, nausea, or both. Only 1 case was administered drugs to activate gastrointestinal motility.Conclusions: We concluded that IPF patients with a mild disease, diagnosis by SLB, or both showed indications of a good response to pirfenidone. In addition, acid-secretion inhibitors may reduce the frequency of anorexia, nausea, or both from pirfenidone. (C) 2013 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.