SAN FRANCISCO — Medications approved by the Food and Drug Administration for the treatment of idiopathic pulmonary fibrosis are significantly under-used in the VA Healthcare System, according to a new study.
The recent report in the journal Chest looked at the usage of two antifibrotic medications, nintedanib and pirfenidone and nintedanib in an effort to elucidate factors associated with uptake among a national cohort of veterans with IPF.1
Researchers from the San Francisco VA Healthcare System and the University of California, San Francisco identified veterans with IPF who received care either provided internally by the VA or non-VA care paid for by the VA. The focus was on those who had filled at least one antifibrotic prescription through the VA pharmacy or Medicare Part D between Oct. 15, 2014, and Dec.31, 2019.
Results indicated that, among 14,792 veterans with IPF, only 17% received antifibrotics. “There were significant disparities in adoption, with lower uptake associated with female sex (adjusted OR, 0.41; 95% CI, 0.27-0.63; P < 0.001), Black race (adjusted OR, 0.60; 95% CI, 0.50-0.74; P < 0.001), and rural residence (adjusted OR, 0.88; 95% CI, 0.80-0.97; P = .012),” the authors advised.
That meant that female patients were 59% less likely to receive antifibrotic agents than male patients, Black patients were 40% less likely to receive antifibrotic agents than white patients, and rural patients were 12% less likely to receive antifibrotic agents than patients living in urban areas.
In addition, the study found that veterans who received their index diagnosis of IPF outside the VA were less likely to receive antifibrotic therapy (adjusted OR, 0.15; 95% CI, 0.10-0.22; P < 0.001).
“This study is the first to evaluate the real-world adoption of antifibrotic medications among veterans with IPF,” the authors pointed out. “Overall uptake was low, and there were significant disparities in use. Interventions to address these issues deserve further investigation.”
The report noted that uptake slowly increased across all subgroups, the disparities grew more pronounced over time. “The results highlight the need for increased focus on the systemic uptake of novel therapies such as antifibrotic medications into routine clinical practice; in addition, as is the case in medicine more broadly, particular attention is needed to address inequities in IPF care,” the authors emphasized.
Researchers also reported that their findings from the VA, the largest integrated health-care system in the United States, “contrast with prior non-VA studies that have used clinical registries to evaluate antifibrotic uptake among patients with IPF. These registry-based studies have reported much higher antifibrotic utilization rates (approaching 70%).”
The authors said they consider the findings in their study more representative of the real-world population, adding that they also are consistent with a real-world data study of Medicare Advantage beneficiaries.
The study also pointed out that antifibrotic agents, in particular, require longitudinal laboratory monitoring of liver function and suggested that the low uptake of antifibrotic agents in outsourced care could be because of care fragmentation, limited access to VA EHRs or uncertainty about longitudinal follow-up with community providers.
“The 17% overall uptake of antifibrotic therapy is disappointing, but perhaps not surprising. Prior implementation science studies have noted that, on average, it takes years for research evidence to reach clinical practice,” the authors wrote.
- Kaul B, Lee JS, Petersen LA, McCulloch C, Rosas IO, Bandi VD, Zhang N, DeDent AM, Collard HR, Whooley MA. Disparities in Antifibrotic Medication Utilization Among Veterans With Idiopathic Pulmonary Fibrosis. Chest. 2023 Feb 18:S0012-3692(23)00273-8. doi: 10.1016/j.chest.2023.02.027. Epub ahead of print. PMID: 36801465.