Delay and inequalities in the treatment of idiopathic pulmonary fibrosis: the case of two Nordic countries

Ida Pesonen; Lisa Carlson; Nicola Murgia; Riitta Kaarteenaho; Carl Magnus Sköld; Marjukka Myllärniemi; Giovanni Murgia

doi:10.4081/mrm.2018.140

Delay and inequalities in the treatment of idiopathic pulmonary fibrosis: the case of two Nordic countries

Authors

Ida Pesonen Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden; Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden http://orcid.org/0000-0001-8977-7462
Lisa Carlson Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm
Nicola Murgia Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Perugia, Italy; Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg
Riitta Kaarteenaho Research Unit of Internal Medicine, University of Oulu and Medical Research Center Oulu, Oulu University Hospital, Oulu,
Carl Magnus Sköld Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm; Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm
Marjukka Myllärniemi University of Helsinki and Helsinki University Hospital, Heart and Lung Center, Helsinki
Giovanni Murgia Department of Respiratory Medicine and Allergy, Karolinska UniversityHospital, Stockholm, Sweden2Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm,

DOI: https://doi.org/10.4081/mrm.2018.140

Keywords:

Idiopathic pulmonary fibrosis, Interstitial lung disease, Nintedanib, Pirfenidone, Access to healthcare

Abstract

Background: Idiopathic pulmonary fibrosis (IPF) is characterized by progressive loss of lung function with high mortality within the first 5 years from diagnosis. In 2011–2014, two drugs, pirfenidone and nintedanib, have been approved worldwide for prevention of IPF progression. National IPF-registries have been established in both Finland and Sweden. Our study explored potential differences in the care of IPF in these two countries.

Methods: Patients included consecutively in the Finnish and Swedish IPF-registries from January 1, 2014 through December 31, 2016 were included in the study. Data on demographics and lung function at the time of inclusion were collected. Access to antifibrotic drugs and data on disease outcomes, mortality and the proportion of patients who underwent lung transplantation, was collected during a 3-year follow up.

Results: One-hundred and fifty-two patients from the Finnish and 160 patients from the Swedish IPF-cohorts were included in the study. At inclusion, Finnish patients were significantly older than the Swedish patients (74.6 years vs 72.5 years, p = 0.017). The proportion of non-smokers was significantly higher in the Finnish cohort (41.7% vs 26.9%, p = 0.007). Forced vital capacity (FVC), % of predicted (78.2 vs 71.7 for Finnish and Swedish patients, respectively, p = 0.01) and diffusion capacity for carbon monoxide (DLCO), % of predicted (53.3 vs 48.2 for Finnish and Swedish patients, respectively, p = 0.002) were significantly higher in the Finnish cohort compared to the Swedish cohort at the time of inclusion. During the 3-year follow up period, 45 (29.6%) Finnish and 111 (69.4%) Swedish patients, respectively, were initiated on treatment with an antifibrotic drug (pirfenidone or nintedanib) (p < 0.001). When comparing possible determinants of treatment, patients with higher FVC % were less likely to start antifibrotic drugs (OR 0.96, 95%CI 0.93–1.00, p < 0.024). To be resident in Sweden was the main determinant for receiving antifibrotic drugs (OR 5.48, 95%CI 2.65–11.33, p < 0.0001). No significant difference in number of deaths and lung transplantation during the follow up period was found.

Conclusions: This study highlights differences concerning how IPF patients are treated in Finland and Sweden. How these differences will influence the long-term outcome of these patients is unknown.