By Dr Deepu
I have written this post giving an overview of the latest IPF guidlines.The update to the 2011 guidelines appeared in the July 15 issue of the American Journal of Respiratory and Critical Care Medicine. At the end I have provided download links for the article and supplements.
Pirfenidone and Nintedanib were recommended for use in idiopathic pulmonary fibrosis (IPF) with a moderate level of confidence, in a guideline update from ATS/ERS/JRS/ALAT
It also mentions that the methods used by guideline panels to appraise the evidence are different than those used by regulatory agencies like FDA when they review applications seeking market approval for the use of pharmacologic agents for treatment of IPF.
The guidline doesnot provide recommendations for one treatment regimen over another. The guideline does not provide suggestions for or against combination regimens or sequential therapies.
The updated guidline has given strong recommendation against using prednisone with azathioprine and N-acetylcysteine,The update also included strong recommendations against use of warfarin or other anticoagulants due to signals for harm in randomized trials in both cases. Both previously had been suggested as not appropriate for most patients but perhaps reasonable for some.
Imatinib and ambrisentan, not previously addressed in the guidelines, got strong recommendations against use in IPF patients. Sildenafil is included in the guidelines, and got a conditional recommendation against use.
The guidelines also updates on the dual endothelin receptor antagonists macitentan and bosentan , it has changed from a strong to a conditional recommendation against use.
The Lung transplantation which was not addressed in 2011 was also included but formulation of recommendation for single vs bilateral lung transplantation was deffered.
There is no change in the recommendation for anatacid therapy and N acetyl cysteine monotherapy which remains as conditional recommendation for use and conditional recommendation against use respectively.
Adverse effects were common with nintedanib therapy, particularly diarrhea, although serious adverse events were not increased and relatively few patients discontinued the drug due to adverse effects.
Pooled results from the pirfenidone trials showed more risk of photosensitivity, fatigue, stomach discomfort, and anorexia with the drug.
I have Provide the links to Download article from ATS.. Happy reading :)
1.http://www.atsjournals.org/doi/suppl/10.1164/rccm.201506-1063ST/suppl_file/executive_summary.pdf
2.http://www.atsjournals.org/doi/suppl/10.1164/rccm.201506-1063ST/suppl_file/raghu_data_supplement.pdf
3.http://www.atsjournals.org/doi/suppl/10.1164/rccm.201506-1063ST/suppl_file/raghu_data_supplement+2.pdf
I have written this post giving an overview of the latest IPF guidlines.The update to the 2011 guidelines appeared in the July 15 issue of the American Journal of Respiratory and Critical Care Medicine. At the end I have provided download links for the article and supplements.
Pirfenidone and Nintedanib were recommended for use in idiopathic pulmonary fibrosis (IPF) with a moderate level of confidence, in a guideline update from ATS/ERS/JRS/ALAT
It also mentions that the methods used by guideline panels to appraise the evidence are different than those used by regulatory agencies like FDA when they review applications seeking market approval for the use of pharmacologic agents for treatment of IPF.
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| Image Shows Comparison of 2015 and 2011 guidelines. Image published in AJRCCM |
The guidline doesnot provide recommendations for one treatment regimen over another. The guideline does not provide suggestions for or against combination regimens or sequential therapies.
The updated guidline has given strong recommendation against using prednisone with azathioprine and N-acetylcysteine,The update also included strong recommendations against use of warfarin or other anticoagulants due to signals for harm in randomized trials in both cases. Both previously had been suggested as not appropriate for most patients but perhaps reasonable for some.
Imatinib and ambrisentan, not previously addressed in the guidelines, got strong recommendations against use in IPF patients. Sildenafil is included in the guidelines, and got a conditional recommendation against use.
The guidelines also updates on the dual endothelin receptor antagonists macitentan and bosentan , it has changed from a strong to a conditional recommendation against use.
The Lung transplantation which was not addressed in 2011 was also included but formulation of recommendation for single vs bilateral lung transplantation was deffered.
There is no change in the recommendation for anatacid therapy and N acetyl cysteine monotherapy which remains as conditional recommendation for use and conditional recommendation against use respectively.
Adverse effects were common with nintedanib therapy, particularly diarrhea, although serious adverse events were not increased and relatively few patients discontinued the drug due to adverse effects.
Pooled results from the pirfenidone trials showed more risk of photosensitivity, fatigue, stomach discomfort, and anorexia with the drug.
I have Provide the links to Download article from ATS.. Happy reading :)
1.http://www.atsjournals.org/doi/suppl/10.1164/rccm.201506-1063ST/suppl_file/executive_summary.pdf
2.http://www.atsjournals.org/doi/suppl/10.1164/rccm.201506-1063ST/suppl_file/raghu_data_supplement.pdf
3.http://www.atsjournals.org/doi/suppl/10.1164/rccm.201506-1063ST/suppl_file/raghu_data_supplement+2.pdf
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