@article{fb72e6097f8d4cae92a935532c3d2ff0,
title = "Anti-fibrotic therapy and lung transplant outcomes in patients with idiopathic pulmonary fibrosis",
abstract = "Background: It is unclear whether continuing anti-fibrotic therapy until the time of lung transplant increases the risk of complications in patients with idiopathic pulmonary fibrosis. Objectives: To investigate whether the time between discontinuation of anti-fibrotic therapy and lung transplant in patients with idiopathic pulmonary fibrosis affects the risk of complications. Methods: We assessed intra-operative and post-transplant complications among patients with idiopathic pulmonary fibrosis who underwent lung transplant and had been treated with nintedanib or pirfenidone continuously for ⩾ 90 days at listing. Patients were grouped according to whether they had a shorter (⩽ 5 medication half-lives) or longer (> 5 medication half-lives) time between discontinuation of anti-fibrotic medication and transplant. Five half-lives corresponded to 2 days for nintedanib and 1 day for pirfenidone. Results: Among patients taking nintedanib (n = 107) or pirfenidone (n = 190), 211 (71.0%) had discontinued anti-fibrotic therapy ⩽ 5 medication half-lives before transplant. Anastomotic and sternal dehiscence occurred only in this group (anastomotic: 11 patients [5.2%], p = 0.031 vs patients with longer time between discontinuation of anti-fibrotic medication and transplant; sternal: 12 patients [5.7%], p = 0.024). No differences were observed in surgical wound dehiscence, length of hospital stay, or survival to discharge between groups with a shorter versus longer time between discontinuation of anti-fibrotic therapy and transplant. Conclusion: Anastomotic and sternal dehiscence only occurred in patients with idiopathic pulmonary fibrosis who discontinued anti-fibrotic therapy < 5 medication half-lives before transplant. The frequency of other intra-operative and post-transplant complications did not appear to differ depending on when anti-fibrotic therapy was discontinued. Registration: clinicaltrials.gov NCT04316780: https://clinicaltrials.gov/ct2/show/NCT04316780",
keywords = "interstitial lung disease, pulmonary fibrosis, surgery, tyrosine kinase, wound healing",
author = "Astor, {Todd L.} and Goldberg, {Hilary J.} and Snyder, {Laurie D.} and Andrew Courtwright and Ramsey Hachem and Tahuanty Pena and Lorenzo Zaffiri and Criner, {Gerard J.} and Budev, {Marie M.} and Tany Thaniyavarn and Leonard, {Thomas B.} and Shaun Bender and Aliaa Barakat and Breeze, {Janis L.} and Peter LaCamera",
note = "Funding Information: The authors thank the patients who participated in this study. The authors thank Arthur Dea of St. Elizabeth{\textquoteright}s Medical Center, Boston, MA, USA, for his assistance for data co-ordination. This study was funded by Boehringer Ingelheim Pharmaceuticals, Inc (BIPI). The authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE). The authors did not receive payment for development of this article. Writing support was provided by Elizabeth Ng and Wendy Morris of FleishmanHillard, London, UK, which was contracted and funded by BIPI. The authors were fully responsible for all content and editorial decisions, were involved at all stages of development and provided their approval on the final version. BI was given the opportunity to review this article for medical and scientific accuracy as well as intellectual property considerations. Funding Information: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: T.L.A., H.J.G., A.C., T.P., M.M.B., T.T., A.B., J.L.B. and P.L. have nothing to disclose other than receiving research funding from BIPI for this project. L.D.S. and L.Z. are faculty members in the Duke Clinical Research Institute, which receives funding support from BIPI to co-ordinate the IPF-PRO/ILD-PRO Registry. R.H. reports grants from Bristol Myers Squibb and Therakos, royalties or licenses from UpToDate, consulting fees from Transmedics, and payment for presentations from CareDx. G.J.C. reports grants and consulting fees from AstraZeneca, BI, Broncus, Chiesi, GlaxoSmithKline, Lungpacer, Mereo BioPharma, Nuvaira, Olympus, Patara Pharma, PneumRx, Pulmonx, ResMed and Respironics; grants from Alung, Fisher & Paykel and Galapagos; and consulting fees from BTG, EOLO, NGM and Verona Pharma. T.B.L. is an employee of BIPI. S.B. was an employee of BIPI at the time that this study was conducted. Publisher Copyright: {\textcopyright} The Author(s), 2023.",
year = "2023",
month = jan,
day = "1",
doi = "10.1177/17534666231165912",
language = "English",
volume = "17",
journal = "Therapeutic Advances in Respiratory Disease",
issn = "1753-4658",
}