S98 Antacid therapy and disease progression in patients with idiopathic pulmonary fibrosis (IPF) under pirfenidone treatment
Bibliographic record
Abstract
<h3>Introduction</h3> On the basis of retrospective and post-hoc analyses the current IPF guideline suggests the use of anti-acid therapy (AAT, i.e., proton pump inhibitors and H2-blockers) as a treatment option in patients with IPF. While recent post-hoc analyses do not support a protective effect of AAT on IPF progression in patients receiving placebo, the impact of AAT on disease progression in patients treated with pirfenidone is unknown. <h3>Methods</h3> Patients with IPF randomised to pirfenidone in 3 trials (CAPACITY studies 004 and 006, and ASCEND) were included. Changes in pulmonary function, exercise tolerance, survival, hospitalizations, and adverse events (AEs) over 52 weeks were analysed for all subjects, based on AAT status at baseline, by bivariate and multivariate analyses. Disease progression was defined as an absolute decrease of forced vital capacity (FVC) ≥10% predicted, a decrease of ≥50 m in the 6-minute walk distance (6MWD) or death. <h3>Results</h3> Of 623 patients, 44% received AAT. Patient characteristics were comparable between groups with the exception of gastrointestinal (GI) comorbidities. In bivariate analyses, there were no significant differences at 52 weeks in disease progression (AAT vs non-AAT: 24.9% vs 30.6%; <i>P</i> = 0.12), all-cause or IPF-related mortality (2.9% vs 4.0%; <i>P</i> = 0.47 and 1.1% vs 2.0%; <i>P</i> = 0.37, respectively), all-cause hospitalisation (16.1% vs. 18.3%, <i>P</i> = 0.48) or observed mean FVC decline (−2.7% vs −3.1%, <i>P</i> = 0.44). Relative but not absolute FVC decline ≥10% was slightly in favour of AAT (15% vs 22%; <i>P</i> = 0.03). In multivariate analyses, hazard ratios across study outcomes ranged from 0.3–0.9 for AAT (vs. non-AAT), although differences were not statistically significant (including relative FVC decline ≥10%). AEs were generally similar between groups; however, severe GI AEs (3.7% vs. 0.9%, <i>P</i> = 0.015) and severe pulmonary infections (3.7% vs. 1.1%, <i>P</i> = 0.035) were more frequent in AAT users. <h3>Conclusion</h3> In this post-hoc analysis of three randomized-controlled trials, there was no clear evidence of benefit of the combination of AAT and pirfenidone compared to pirfenidone alone. However, AAT use appeared to increase the risk of severe GI and infectious AEs. AAT should be prospectively assessed in a randomised controlled trial before being considered as a specific treatment for IPF.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".