b'Antifibrotic Medications Underused for IPF Treatment With Internal, Outside VA Care By Brenda L. MooneySAN FRANCISCOMedications approved by theInterventions to address these issues deserve further FoodandDrugAdministrationforthetreatmentinvestigation.ofidiopathicpulmonaryfibrosisaresignificantly Thereportnotedthat,whileuptakeslowly underused in the VA Healthcare System, accordingincreased across all subgroups, the disparities grew to a new study. more pronounced over time. The results highlight The recent report in the journal Chest looked at thethe need for increased focus on the systemic uptake usageoftwoantifibroticmedications,nintedanibof novel therapies such as antifibrotic medications and pirfenidone and nintedanib in an effort to eluci- into routine clinical practice; in addition, as is the date factors associated with uptake among a nationalcase in medicine more broadly, particular attention is cohort of veterans with IPF. 1 needed to address inequities in IPF care, the authors Researchers from the San Francisco VA Healthcareemphasized.SystemandtheUniversityofCaliforniaSanTheresearchersalsoreportedthattheirfindings Francisco identified veterans with IPF who receivedfrom the VA, the largest integrated healthcare sys-care either provided internally by the VA or non- tem in the United States, contrast with prior non-VA VA care paid for by the VA. The focus was on thosestudies that have used clinical registries to evaluate whohadfilledatleastoneantifibroticprescrip- antifibrotic uptake among patients with IPF. These tion through the VA pharmacy or Medicare Part Dregistry-basedstudieshavereportedmuchhigher between Oct. 15, 2014, and Dec.31, 2019. antifibrotic utilization rates (approaching 70%).The results indicated that, among 14,792 veteransThe authors said they consider the findings in their withIPF,only17%receivedantifibrotics.Therestudy more representative of the real-world popu-were significant disparities in adoption, with lowerlation,addingthattheyalsoareconsistentwith uptakeassociatedwithfemalesex(adjustedOR,areal-worlddatastudyofMedicareAdvantage 0.41;95%CI,0.27-0.63;P0.001),Blackracebeneficiaries.(adjusted OR, 0.60; 95% CI, 0.50-0.74; P 0.001),The study also pointed out that antifibrotic agents, andruralresidence(adjustedOR,0.88;95%CI,in particular, require longitudinal laboratory moni-0.80-0.97; P = .012), the authors advised.toring of liver function and suggested that the low Thatmeantthatfemalepatientswere59%lessuptake of antifibrotic agents in outsourced care could likelytoreceiveantifibroticagentsthanmalebe because of care fragmentation, limited access to patients,Blackpatientswere40%lesslikelytoVA EHRs or uncertainty about longitudinal follow-receive antifibrotic agents than white patients, andup with community providers.rural patients were 12% less likely to receive antifi- The17%overalluptakeofantifibrotictherapy brotic agents than patients living in urban areas. isdisappointingbutperhapsnotsurprising.Prior Inaddition,thestudyfoundthatveteranswhoimplementation science studies have noted that, on receivedtheirindexdiagnosisofIPFoutsidetheaverage, it takes years for research evidence to reach VA were less likely to receive antifibrotic therapyclinical practice, the authors wrote.(adjusted OR, 0.15; 95% CI, 0.10-0.22; P 0.001). 1Kaul B, Lee JS, Petersen LA, McCulloch C, Rosas IO, Bandi VD, This study is the first to evaluate the real-worldZhang N, DeDent AM, Collard HR, Whooley MA. Disparities in Anti-adoption of antifibrotic medications among veteransfibrotic Medication Utilization Among Veterans With Idiopathic Pul-with IPF, the authors pointed out. Overall uptakemonary Fibrosis. Chest. 2023 Feb 18:S0012-3692(23)00273-8. doi: was low, and there were significant disparities in use.10.1016/j.chest.2023.02.027. Epub ahead of print. PMID: 36801465.100'