Antifibrotic therapy can be started in patients with a working diagnosis of idiopathic pulmonary fibrosis (IPF) without requiring surgical lung biopsy (SLB), respiratory physicians say.
Their recommendation is based on a review of outcomes of patients who had possible usual interstitial pneumonia (UIP) pattern on high-resolution CT imaging who received antifibrotics following consensus diagnosis by expert multidisciplinary teams without SLB. These patients achieved similar outcomes to patients receiving therapy after a definite IPF diagnosis, a study from Italy found.
The current gold standard approach to diagnosing IPF in patients clinically suspected of having the disease involves identification of either a usual interstitial pneumonia (UIP) pattern on high-resolution computed tomography (HRCT) or a combination of HRCT and lung biopsy when imaging is uncertain. A multidisciplinary discussion plays a key role in determining who should undergo biopsy.
But researchers in Italy, who investigated mortality rate and disease progression in 249 IPF patients on antifibrotic therapy across multiple sites, say a substantial proportion of patients with suspected IPF either cannot or are not willing to undergo the invasive procedure, and may be denied access to newly available treatment options because they do not meet diagnostic criteria.
Dr Giacom Sgalla and colleagues retrospectively looked at two IPF diagnostic subgroups: patients with a definite UIP pattern on HRCT and patients with possible UIP on HRCT and no SLB who received ‘a working diagnosis’ of IPF following consensus through multidisciplinary discussion (MDD).
According to investigators, IPF patients with possible UIP pattern on HRCT and no SLB showed similar survival rates as compared to IPF patients with definite UIP pattern on HRCT or SLB – a finding that was maintained when patients were stratified by GAP (gender, age and physiology) stage.
Time to disease progression, defined as time to death, 10% absolute decline in FVC or 50 m reduction in 6MWD, was also not significantly different between the two groups.
Physicians tended to avoid invasive procedures to diagnose the condition, said investigators who reported that a ‘noticeable’ proportion of IPF patients in the cohort (16.5%) and more than half of the patients with a possible UIP on HRCT received IPF diagnosis and antifibrotic treatment without requiring SLB.