Multidisciplinary support at nintedanib initiation is associated with higher 12-month treatment continuation in
Yoshiaki Kinoshita1, Ryo Ogata1, Kazumoto Eshima1
1Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka, 818-8502, Japan.
Background:
Nintedanib is an effective antifibrotic treatment for interstitial lung diseases. However, adverse events often lead to discontinuation. We examined whether a multidisciplinary support pathway at the initiation of treatment was associated with continued nintedanib therapy.
Methods:
In this single-center observational study, patients prospectively enrolled in a 7-day multidisciplinary inpatient pathway were compared with historical controls receiving standard care. The primary analysis assessed 12-month treatment continuation after nintedanib initiation, defining discontinuation for any reason other than death as an event. Secondary analyses assessed all-cause discontinuation and repeated the primary analysis among patients with at least 12 months of potential follow-up.
Results:
Among 113 patients, 42 received multidisciplinary support and 71 standard care. Within 12 months, treatment discontinuation occurred in 6 and 27 patients, respectively. The Kaplan-Meier-estimated 12-month treatment continuation rates were 85.3% and 59.3%, respectively (log-rank p = 0.027). Multidisciplinary support was associated with a lower discontinuation risk (hazard ratio 0.38, 95% confidence interval 0.16-0.93, p = 0.033). In the all-cause analysis, the Kaplan-Meier-estimated 12-month treatment continuation rates were 76.9% and 52.3% (log-rank p = 0.037). The association persisted in patients with sufficient potential follow-up (log-rank p = 0.035). Any adverse event occurred at similar frequencies (73.8% vs. 73.2%).
Conclusions:
A multidisciplinary support pathway was associated with higher 12-month treatment continuation than standard care, although confirmation in larger contemporaneous cohorts is required.
