The influence of symptoms on uptake of antifibrotic medication – experience from a UK tertiary Interstitial Lung Disease (ILD) centre

<bold>Introduction</bold> Since May 2023 patients at Leeds Teaching Hospitals NHS Trust with idiopathic pulmonary fibrosis (IPF) and forced vital capacity (FVC) above 80% have been eligible for the antifibrotic Nintedanib. We examined factors affecting uptake of Nintedanib in this cohort. <bold>Methods</bold> We retrospectively reviewed patients with IPF and FVC >80% who were offered Nintedanib between May – July 2023. Patients were identified using our electronic patient record. Patients were given standard information about the benefits and side effects of Nintedanib and were categorised into Nintedanib starters or other outcomes. Group comparisons were performed using student’s T-test, Mann-Whitney U test or Fisher exact test as appropriate. <bold>Results</bold> 44 patients met the inclusion criteria. <table-wrap><object-id>erj;64/suppl_68/PA5143/T1</object-id><object-id>T1</object-id><object-id>t1</object-id><table><colgroup><col></col><col></col><col></col><col></col></colgroup><tbody><tr><td></td><td><bold>Started Nintedanib n=20</bold></td><td><bold>Other outcomes*</bold> <bold>n=24</bold></td><td><bold>p-value</bold></td></tr><tr><td><bold>Demographics</bold></td></tr><tr><td>Age (years) mean(95%CI)</td><td>78(67-88)</td><td>83(76-90)</td><td><bold>0.022</bold></td></tr><tr><td> FVC% median(IQR) </td><td>94(91-103)</td><td>103(92-111)</td><td>0.128</td></tr><tr><td><bold>Reported symptoms n(%)</bold></td></tr><tr><td>Symptomatic</td><td>18(90%)</td><td>11(46%)</td><td><bold>0.002</bold></td></tr><tr><td>Asymptomatic</td><td>2(10%)</td><td>13(54%)</td><td></td></tr></tbody></table></table-wrap> <italic>*Other outcomes: pulmonary function test monitoring, discharge, undecided</italic> 45% of patients started Nintedanib; they were significantly younger and more symptomatic than non-starters. Binary logistic regression analysis identified symptomatic patients (regression coefficient 2.1 p=0.021) as independently associated with starting Nintedanib. Sensitivity power analysis suggested our sample size was adequate to identify moderate effect sizes. <bold>Conclusion</bold> Despite eligibility, over half of patients did not elect to start Nintedanib when offered. Younger patients with symptoms were significantly more likely to initiate Nintedanib than those without symptoms.