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Immunomodulatory treatment in unclassifiable interstitial lung disease: A retrospective study of treatment response
Background and Objective The optimal management of unclassifiable Interstitial lung disease (ILD) remains a challenge. The aim of this study was to describe pulmonary function trajectories for patients treated with immunomodulatory therapy and for untreated patients. Methods Clinical information and...
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| Published in: | Respirology (Carlton, Vic.) Vic.), 2023-04, Vol.28 (4), p.373-379 |
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| creator | Hyldgaard, Charlotte Torrisi, Sebastiano Kronborg Brix‐White, Sissel Prior, Thomas Skovhus Ganter, Claudia Bendstrup, Elisabeth Kreuter, Michael |
| description | Background and Objective
The optimal management of unclassifiable Interstitial lung disease (ILD) remains a challenge. The aim of this study was to describe pulmonary function trajectories for patients treated with immunomodulatory therapy and for untreated patients.
Methods
Clinical information and treatment data were obtained retrospectively at two ILD centres. Pulmonary function data were analysed using (1) mixed effects linear regression models with and without clinical covariates and (2) propensity score matching using gender, age, physiology (GAP) stage, smoking and presence of ground glass opacities.
Results
Sixty‐five percent of the 249 patients included received corticosteroids and/or other immunomodulators. Treated patients had lower forced vital capacity (FVC) (72% vs. 83% predicted) and diffusing capacity for carbon monoxide (DLco) (44% vs. 60% predicted). In mixed effects linear regression, the adjusted change in FVC was −0.22%, [−0.34; −0.11], and −0.15% [−0.28;‐0.012] for DLco. The difference in pulmonary function decline between treated and untreated patients was insignificant, −0.082% per month, [−0.28; 0.11], p = 0.10 for FVC and −0.14% per month, [−0.36; 0.079], p = 0.15, for DLco. In propensity score matched analysis, the difference in change in FVC was 0.039% per month, p = 0.12, and for DLco, 0.0085% per month, p = 0.7.
Conclusion
The pulmonary function trajectories for treated and untreated patients were parallel, despite treated patients having more severe disease at baseline. The persisting differences between the groups suggest no overall effect, although improvement or stabilization may be seen in some patients. Prospective studies are needed to define subsets of patients with unclassifiable interstitial lung disease and their optimal management.
Patients with unclassifiable interstitial lung disease who received immunomodulatory therapy had similar pulmonary function trajectories as patients who did not receive therapy despite more severe disease at baseline in treated patients. This suggests a lack of overall improvement, although immunomodulatory therapy may have effect in a subgroup of patients. |
| doi_str_mv | 10.1111/resp.14409 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2736304561</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2793388786</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3939-bafab692c00a661f005a0d04786a4c066bc579fb4cd2f78e12d1aaf7577939c3</originalsourceid><addsrcrecordid>eNp9kUtLJTEQhcOg-N7MD5CAm0FoTTr9ijsRXyDMMOO-SacrEkl3rqlEuf9-cr0q4sJsKhQfp86pIuQnZyc8v9MAuDjhVcXkD7KzqgXvKrGR_6IURdtKuU12ER8ZY6Jm9RbZFo1oy7ZrdgjeTlOa_eTH5FT0YUljABUnmCO1M02zdgrRGqsGB7kTIWC00SpHXZof6GgRFMIZPacBYvC4AB3tM1CMaVxSbz7prXz6GWGfbBrlEA7e6h65v7q8v7gp7n5f316c3xVaSCGLQRk1NLLUjKmm4YaxWrGRVdm3qjRrmkHXrTRDpcfStB3wcuRKmbbOiYXUYo_8Wssugn9KgLGfLGpwTs3gE_Zlm9fAqrrhGT36gj76FOZsLlNSiK7LQzN1vKZ0zokBTL8IdlJh2XPWry7RrxL2r5fI8OGbZBomGD_Q99VngK-BF-tg-Y1U__fy35-16H9veJZX</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2793388786</pqid></control><display><type>article</type><title>Immunomodulatory treatment in unclassifiable interstitial lung disease: A retrospective study of treatment response</title><source>Wiley-Blackwell Journals</source><creator>Hyldgaard, Charlotte ; Torrisi, Sebastiano ; Kronborg Brix‐White, Sissel ; Prior, Thomas Skovhus ; Ganter, Claudia ; Bendstrup, Elisabeth ; Kreuter, Michael</creator><creatorcontrib>Hyldgaard, Charlotte ; Torrisi, Sebastiano ; Kronborg Brix‐White, Sissel ; Prior, Thomas Skovhus ; Ganter, Claudia ; Bendstrup, Elisabeth ; Kreuter, Michael</creatorcontrib><description>Background and Objective
The optimal management of unclassifiable Interstitial lung disease (ILD) remains a challenge. The aim of this study was to describe pulmonary function trajectories for patients treated with immunomodulatory therapy and for untreated patients.
Methods
Clinical information and treatment data were obtained retrospectively at two ILD centres. Pulmonary function data were analysed using (1) mixed effects linear regression models with and without clinical covariates and (2) propensity score matching using gender, age, physiology (GAP) stage, smoking and presence of ground glass opacities.
Results
Sixty‐five percent of the 249 patients included received corticosteroids and/or other immunomodulators. Treated patients had lower forced vital capacity (FVC) (72% vs. 83% predicted) and diffusing capacity for carbon monoxide (DLco) (44% vs. 60% predicted). In mixed effects linear regression, the adjusted change in FVC was −0.22%, [−0.34; −0.11], and −0.15% [−0.28;‐0.012] for DLco. The difference in pulmonary function decline between treated and untreated patients was insignificant, −0.082% per month, [−0.28; 0.11], p = 0.10 for FVC and −0.14% per month, [−0.36; 0.079], p = 0.15, for DLco. In propensity score matched analysis, the difference in change in FVC was 0.039% per month, p = 0.12, and for DLco, 0.0085% per month, p = 0.7.
Conclusion
The pulmonary function trajectories for treated and untreated patients were parallel, despite treated patients having more severe disease at baseline. The persisting differences between the groups suggest no overall effect, although improvement or stabilization may be seen in some patients. Prospective studies are needed to define subsets of patients with unclassifiable interstitial lung disease and their optimal management.
Patients with unclassifiable interstitial lung disease who received immunomodulatory therapy had similar pulmonary function trajectories as patients who did not receive therapy despite more severe disease at baseline in treated patients. This suggests a lack of overall improvement, although immunomodulatory therapy may have effect in a subgroup of patients.</description><identifier>ISSN: 1323-7799</identifier><identifier>EISSN: 1440-1843</identifier><identifier>DOI: 10.1111/resp.14409</identifier><identifier>PMID: 36372786</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Carbon monoxide ; Corticosteroids ; Humans ; Immunomodulation ; immunomodulatory therapy ; Lung - diagnostic imaging ; Lung diseases ; Lung Diseases, Interstitial - drug therapy ; lung fibrosis ; Patients ; pulmonary function ; rare lung disease ; Regression analysis ; Respiratory function ; Retrospective Studies ; Tidal Volume ; unclassifiable interstitial lung disease ; Vital Capacity</subject><ispartof>Respirology (Carlton, Vic.), 2023-04, Vol.28 (4), p.373-379</ispartof><rights>2022 The Authors. published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.</rights><rights>2022 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.</rights><rights>2022. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3939-bafab692c00a661f005a0d04786a4c066bc579fb4cd2f78e12d1aaf7577939c3</citedby><cites>FETCH-LOGICAL-c3939-bafab692c00a661f005a0d04786a4c066bc579fb4cd2f78e12d1aaf7577939c3</cites><orcidid>0000-0002-6353-8671 ; 0000-0002-4238-6963 ; 0000-0002-5526-5079</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fresp.14409$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fresp.14409$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>315,786,790,27957,27958,50923,51032</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36372786$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hyldgaard, Charlotte</creatorcontrib><creatorcontrib>Torrisi, Sebastiano</creatorcontrib><creatorcontrib>Kronborg Brix‐White, Sissel</creatorcontrib><creatorcontrib>Prior, Thomas Skovhus</creatorcontrib><creatorcontrib>Ganter, Claudia</creatorcontrib><creatorcontrib>Bendstrup, Elisabeth</creatorcontrib><creatorcontrib>Kreuter, Michael</creatorcontrib><title>Immunomodulatory treatment in unclassifiable interstitial lung disease: A retrospective study of treatment response</title><title>Respirology (Carlton, Vic.)</title><addtitle>Respirology</addtitle><description>Background and Objective
The optimal management of unclassifiable Interstitial lung disease (ILD) remains a challenge. The aim of this study was to describe pulmonary function trajectories for patients treated with immunomodulatory therapy and for untreated patients.
Methods
Clinical information and treatment data were obtained retrospectively at two ILD centres. Pulmonary function data were analysed using (1) mixed effects linear regression models with and without clinical covariates and (2) propensity score matching using gender, age, physiology (GAP) stage, smoking and presence of ground glass opacities.
Results
Sixty‐five percent of the 249 patients included received corticosteroids and/or other immunomodulators. Treated patients had lower forced vital capacity (FVC) (72% vs. 83% predicted) and diffusing capacity for carbon monoxide (DLco) (44% vs. 60% predicted). In mixed effects linear regression, the adjusted change in FVC was −0.22%, [−0.34; −0.11], and −0.15% [−0.28;‐0.012] for DLco. The difference in pulmonary function decline between treated and untreated patients was insignificant, −0.082% per month, [−0.28; 0.11], p = 0.10 for FVC and −0.14% per month, [−0.36; 0.079], p = 0.15, for DLco. In propensity score matched analysis, the difference in change in FVC was 0.039% per month, p = 0.12, and for DLco, 0.0085% per month, p = 0.7.
Conclusion
The pulmonary function trajectories for treated and untreated patients were parallel, despite treated patients having more severe disease at baseline. The persisting differences between the groups suggest no overall effect, although improvement or stabilization may be seen in some patients. Prospective studies are needed to define subsets of patients with unclassifiable interstitial lung disease and their optimal management.
Patients with unclassifiable interstitial lung disease who received immunomodulatory therapy had similar pulmonary function trajectories as patients who did not receive therapy despite more severe disease at baseline in treated patients. This suggests a lack of overall improvement, although immunomodulatory therapy may have effect in a subgroup of patients.</description><subject>Carbon monoxide</subject><subject>Corticosteroids</subject><subject>Humans</subject><subject>Immunomodulation</subject><subject>immunomodulatory therapy</subject><subject>Lung - diagnostic imaging</subject><subject>Lung diseases</subject><subject>Lung Diseases, Interstitial - drug therapy</subject><subject>lung fibrosis</subject><subject>Patients</subject><subject>pulmonary function</subject><subject>rare lung disease</subject><subject>Regression analysis</subject><subject>Respiratory function</subject><subject>Retrospective Studies</subject><subject>Tidal Volume</subject><subject>unclassifiable interstitial lung disease</subject><subject>Vital Capacity</subject><issn>1323-7799</issn><issn>1440-1843</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><recordid>eNp9kUtLJTEQhcOg-N7MD5CAm0FoTTr9ijsRXyDMMOO-SacrEkl3rqlEuf9-cr0q4sJsKhQfp86pIuQnZyc8v9MAuDjhVcXkD7KzqgXvKrGR_6IURdtKuU12ER8ZY6Jm9RbZFo1oy7ZrdgjeTlOa_eTH5FT0YUljABUnmCO1M02zdgrRGqsGB7kTIWC00SpHXZof6GgRFMIZPacBYvC4AB3tM1CMaVxSbz7prXz6GWGfbBrlEA7e6h65v7q8v7gp7n5f316c3xVaSCGLQRk1NLLUjKmm4YaxWrGRVdm3qjRrmkHXrTRDpcfStB3wcuRKmbbOiYXUYo_8Wssugn9KgLGfLGpwTs3gE_Zlm9fAqrrhGT36gj76FOZsLlNSiK7LQzN1vKZ0zokBTL8IdlJh2XPWry7RrxL2r5fI8OGbZBomGD_Q99VngK-BF-tg-Y1U__fy35-16H9veJZX</recordid><startdate>202304</startdate><enddate>202304</enddate><creator>Hyldgaard, Charlotte</creator><creator>Torrisi, Sebastiano</creator><creator>Kronborg Brix‐White, Sissel</creator><creator>Prior, Thomas Skovhus</creator><creator>Ganter, Claudia</creator><creator>Bendstrup, Elisabeth</creator><creator>Kreuter, Michael</creator><general>John Wiley & Sons, Ltd</general><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6353-8671</orcidid><orcidid>https://orcid.org/0000-0002-4238-6963</orcidid><orcidid>https://orcid.org/0000-0002-5526-5079</orcidid></search><sort><creationdate>202304</creationdate><title>Immunomodulatory treatment in unclassifiable interstitial lung disease: A retrospective study of treatment response</title><author>Hyldgaard, Charlotte ; Torrisi, Sebastiano ; Kronborg Brix‐White, Sissel ; Prior, Thomas Skovhus ; Ganter, Claudia ; Bendstrup, Elisabeth ; Kreuter, Michael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3939-bafab692c00a661f005a0d04786a4c066bc579fb4cd2f78e12d1aaf7577939c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Carbon monoxide</topic><topic>Corticosteroids</topic><topic>Humans</topic><topic>Immunomodulation</topic><topic>immunomodulatory therapy</topic><topic>Lung - diagnostic imaging</topic><topic>Lung diseases</topic><topic>Lung Diseases, Interstitial - drug therapy</topic><topic>lung fibrosis</topic><topic>Patients</topic><topic>pulmonary function</topic><topic>rare lung disease</topic><topic>Regression analysis</topic><topic>Respiratory function</topic><topic>Retrospective Studies</topic><topic>Tidal Volume</topic><topic>unclassifiable interstitial lung disease</topic><topic>Vital Capacity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hyldgaard, Charlotte</creatorcontrib><creatorcontrib>Torrisi, Sebastiano</creatorcontrib><creatorcontrib>Kronborg Brix‐White, Sissel</creatorcontrib><creatorcontrib>Prior, Thomas Skovhus</creatorcontrib><creatorcontrib>Ganter, Claudia</creatorcontrib><creatorcontrib>Bendstrup, Elisabeth</creatorcontrib><creatorcontrib>Kreuter, Michael</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Wiley-Blackwell Open Access Backfiles</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Respirology (Carlton, Vic.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hyldgaard, Charlotte</au><au>Torrisi, Sebastiano</au><au>Kronborg Brix‐White, Sissel</au><au>Prior, Thomas Skovhus</au><au>Ganter, Claudia</au><au>Bendstrup, Elisabeth</au><au>Kreuter, Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Immunomodulatory treatment in unclassifiable interstitial lung disease: A retrospective study of treatment response</atitle><jtitle>Respirology (Carlton, Vic.)</jtitle><addtitle>Respirology</addtitle><date>2023-04</date><risdate>2023</risdate><volume>28</volume><issue>4</issue><spage>373</spage><epage>379</epage><pages>373-379</pages><issn>1323-7799</issn><eissn>1440-1843</eissn><notes>Funding information</notes><notes>Hoffmann la Roche; Roche</notes><notes>Elisabeth Bendstrup and Michael Kreuter contributed equally to this study.</notes><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Background and Objective
The optimal management of unclassifiable Interstitial lung disease (ILD) remains a challenge. The aim of this study was to describe pulmonary function trajectories for patients treated with immunomodulatory therapy and for untreated patients.
Methods
Clinical information and treatment data were obtained retrospectively at two ILD centres. Pulmonary function data were analysed using (1) mixed effects linear regression models with and without clinical covariates and (2) propensity score matching using gender, age, physiology (GAP) stage, smoking and presence of ground glass opacities.
Results
Sixty‐five percent of the 249 patients included received corticosteroids and/or other immunomodulators. Treated patients had lower forced vital capacity (FVC) (72% vs. 83% predicted) and diffusing capacity for carbon monoxide (DLco) (44% vs. 60% predicted). In mixed effects linear regression, the adjusted change in FVC was −0.22%, [−0.34; −0.11], and −0.15% [−0.28;‐0.012] for DLco. The difference in pulmonary function decline between treated and untreated patients was insignificant, −0.082% per month, [−0.28; 0.11], p = 0.10 for FVC and −0.14% per month, [−0.36; 0.079], p = 0.15, for DLco. In propensity score matched analysis, the difference in change in FVC was 0.039% per month, p = 0.12, and for DLco, 0.0085% per month, p = 0.7.
Conclusion
The pulmonary function trajectories for treated and untreated patients were parallel, despite treated patients having more severe disease at baseline. The persisting differences between the groups suggest no overall effect, although improvement or stabilization may be seen in some patients. Prospective studies are needed to define subsets of patients with unclassifiable interstitial lung disease and their optimal management.
Patients with unclassifiable interstitial lung disease who received immunomodulatory therapy had similar pulmonary function trajectories as patients who did not receive therapy despite more severe disease at baseline in treated patients. This suggests a lack of overall improvement, although immunomodulatory therapy may have effect in a subgroup of patients.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>36372786</pmid><doi>10.1111/resp.14409</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-6353-8671</orcidid><orcidid>https://orcid.org/0000-0002-4238-6963</orcidid><orcidid>https://orcid.org/0000-0002-5526-5079</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley-Blackwell Journals |
| subjects | Carbon monoxide Corticosteroids Humans Immunomodulation immunomodulatory therapy Lung - diagnostic imaging Lung diseases Lung Diseases, Interstitial - drug therapy lung fibrosis Patients pulmonary function rare lung disease Regression analysis Respiratory function Retrospective Studies Tidal Volume unclassifiable interstitial lung disease Vital Capacity |
| title | Immunomodulatory treatment in unclassifiable interstitial lung disease: A retrospective study of treatment response |
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