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Obstacles to early treatment of idiopathic pulmonary fibrosis: current perspectives

Authors Moua T, Ryu JH

Received 1 October 2018

Accepted for publication 13 December 2018

Published 3 January 2019 Volume 2019:15 Pages 73—81

DOI https://doi.org/10.2147/TCRM.S160248

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Professor Garry Walsh


Teng Moua, Jay H Ryu

Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN, USA

Abstract: Idiopathic pulmonary fibrosis is a progressive and fatal fibrotic lung disease which has seen new opportunity for drug treatment in the last several years with the approval of nintedanib and pirfenidone, two antifibrotic agents aimed at slowing decline in lung function as defined by FVC on pulmonary function testing. Despite these promising effects, delays in drug initiation have been reported undermining the premise that earlier drug initiation may sustain lung function and prolong survival. This review explores obstacles to earlier treatment, inclusive of defining so-called early idiopathic pulmonary fibrosis, difficulties in achieving a confident diagnosis in that setting, and uncertainties regarding drug-related benefits among specific patient subgroups such as those with no symptoms or advanced disease at presentation. Goals of therapy balanced with the burdens associated with antifibrotic drug therapy are negotiated on an individual basis. We review the evidence for and against earlier initiation of antifibrotic drug therapy along with its role in patient-centered outcomes.

Keywords: idiopathic pulmonary fibrosis, nintedanib, pirfenidone, antifibrotics

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