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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Alive and on Initial Antifibrotic Treatment: Real-World Treatment Durability in Idiopathic and Progressive Pulmonary Fibrosis

  • Fatma Isil Uzel1
  • Ferhan Karataş1
  • Burak Uzel2
  • Yüksel Peker1,3,4,5
5 affiliations
  1. 1Department of Pulmonary Medicine, School of Medicine, Koç University, Istanbul 34010, Türkiye
  2. 2Department of Internal Medicine, Medicana Ataköy Hospital, Istanbul 34158, Türkiye
  3. 3Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden
  4. 4Respiratory Medicine and Allergology, Department of Clinical Sciences, Faculty of Medicine, Lund University, 22185 Lund, Sweden
  5. 5Division of Pulmonary, Allergy, and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Abstract

Background: Conventional antifibrotic treatment persistence reflects medication retention but may not fully capture whether patients remain both alive and on their initial therapy. We evaluated alive and on initial treatment (AOIT) as a clinically oriented measure of treatment durability in idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF). Methods: This retrospective single-center cohort included adults with IPF or PPF treated with pirfenidone or nintedanib between 2018 and 2026. AOIT was defined as the time from antifibrotic initiation to permanent discontinuation/switching or death while known to remain on initial treatment. Kaplan–Meier and Cox regression analyses were performed. Results: Among 86 patients, 37 (43.0%) experienced AOIT loss, including 26 discontinuation/switch events and 11 deaths. AOIT was 75.1%, 63.6% and 46.9% at 12, 24, and 36 months, respectively; median AOIT was 34.9 months (95% CI 21.3–48.4). AOIT did not differ between nintedanib and pirfenidone (log-rank p = 0.395). First-drug persistence was 80.0%, 71.7%, and 61.7% at the corresponding time points, with a median of 52.2 months (95% CI 31.2–73.2). Malignancy (adjusted HR 5.00, 95% CI 1.91–13.09, p = 0.001) and higher baseline DLCO (adjusted HR 1.67 per 10-percentage-point increase, 95% CI 1.21–2.29; p = 0.002) were associated with AOIT loss. Conclusions: AOIT declined over time and was numerically lower than first-drug persistence, reflecting distinct aspects of longitudinal treatment durability. AOIT may complement medication-centered persistence in real-world antifibrotic treatment assessment.

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Cite

BibTeXRIS
BibTeX
@article{uzel2026alive,
  title = {{Alive and on Initial Antifibrotic Treatment: Real-World Treatment Durability in Idiopathic and Progressive Pulmonary Fibrosis}},
  author = {Fatma Isil Uzel and Ferhan Karataş and Burak Uzel and Yüksel Peker},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = nov,
  doi = {10.3390/jcm15218712},
  url = {https://www.mdpi.com/2077-0383/15/21/8712},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Alive and on Initial Antifibrotic Treatment: Real-World Treatment Durability in Idiopathic and Progressive Pulmonary Fibrosis
AU  - Fatma Isil Uzel
AU  - Ferhan Karataş
AU  - Burak Uzel
AU  - Yüksel Peker
PY  - 2026
DA  - 2026/11/08
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218712
UR  - https://www.mdpi.com/2077-0383/15/21/8712
AB  - Background: Conventional antifibrotic treatment persistence reflects medication retention but may not fully capture whether patients remain both alive and on their initial therapy. We evaluated alive and on initial treatment (AOIT) as a clinically oriented measure of treatment durability in idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF). Methods: This retrospective single-center cohort included adults with IPF or PPF treated with pirfenidone or nintedanib between 2018 and 2026. AOIT was defined as the time from antifibrotic initiation to permanent discontinuation/switching or death while known to remain on initial treatment. Kaplan–Meier and Cox regression analyses were performed. Results: Among 86 patients, 37 (43.0%) experienced AOIT loss, including 26 discontinuation/switch events and 11 deaths. AOIT was 75.1%, 63.6% and 46.9% at 12, 24, and 36 months, respectively; median AOIT was 34.9 months (95% CI 21.3–48.4). AOIT did not differ between nintedanib and pirfenidone (log-rank p = 0.395). First-drug persistence was 80.0%, 71.7%, and 61.7% at the corresponding time points, with a median of 52.2 months (95% CI 31.2–73.2). Malignancy (adjusted HR 5.00, 95% CI 1.91–13.09, p = 0.001) and higher baseline DLCO (adjusted HR 1.67 per 10-percentage-point increase, 95% CI 1.21–2.29; p = 0.002) were associated with AOIT loss. Conclusions: AOIT declined over time and was numerically lower than first-drug persistence, reflecting distinct aspects of longitudinal treatment durability. AOIT may complement medication-centered persistence in real-world antifibrotic treatment assessment.
SN  - 2077-0383
ER  -