Association of angiotensin modulators with the course of idiopathic pulmonary fibrosis

• Verfasst von: Kreuter, Michael [VerfasserIn]
• Verfasst von: Lederer, David [VerfasserIn]
• Verfasst von: Molina-Molina, Maria [VerfasserIn]
• Verfasst von: Noth, Imre [VerfasserIn]
• Verfasst von: Valenzuela, Claudia [VerfasserIn]
• Verfasst von: Frankenstein, Lutz [VerfasserIn]
• Verfasst von: Weycker, Derek [VerfasserIn]
• Verfasst von: Atwood, Mark [VerfasserIn]
• Verfasst von: Kirchgaessler, Klaus-Uwe [VerfasserIn]
• Verfasst von: Cottin, Vincent [VerfasserIn]
• Titel: Association of angiotensin modulators with the course of idiopathic pulmonary fibrosis
• Verf.angabe: Michael Kreuter, David J. Lederer, Maria Molina-Molina, Imre Noth, Claudia Valenzuela, Lutz Frankenstein, Derek Weycker, Mark Atwood, Klaus-Uwe Kirchgaessler, and Vincent Cottin
• E-Jahr: 2019
• Jahr: 29 April 2019
• Umfang: 9 S.
• Fussnoten: Gesehen am 10.02.2020
• Titel Quelle: Enthalten in: Chest
• Ort Quelle: Amsterdam : Elsevier, 1935
• Jahr Quelle: 2019
• Band/Heft Quelle: 156(2019), 4, Seite 706-714
• ISSN Quelle: 1931-3543
• DOI: doi:10.1016/j.chest.2019.04.015
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: disease progression
• Sach-SW: idiopathic pulmonary fibrosis
• Sach-SW: interstitial lung disease
• K10plus-PPN: 1689724935

Abstract

Background - Angiotensin peptides have been implicated in idiopathic pulmonary fibrosis (IPF) pathogenesis. Angiotensin modulators are used to treat arterial hypertension, a frequent comorbidity of IPF. This post hoc analysis evaluated associations of antihypertensive treatments with disease-related outcomes in IPF. - Methods - All patients randomized to placebo (n = 624) in the CAPACITY and ASCEND studies were categorized by antihypertensive treatment at baseline. Outcomes of disease progression (first occurrence of ≥ 10% absolute decline in % predicted FVC, ≥ 50-m decline in 6-min walk distance, or death) and all-cause mortality were assessed over 52 weeks. - Results - At baseline, 111 and 121 patients were receiving an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin II receptor blocker (ARB), respectively; 392 were receiving neither. In multivariable analyses adjusted for differences in baseline characteristics compared with the non-ACEi/ARB group, ACEi treatment (hazard ratio [HR], 0.6 [95% CI, 0.4-0.9]; P = .026), but not ARB (HR, 0.9 [95% CI, 0.6-1.2]; P = .413), was associated with slower disease progression. Furthermore, the increase in all-cause mortality associated with cardiovascular disease was not observed in the ACEi group (HR, 1.1 [95% CI, 0.5-2.9]; P = .782), which presented a similar percentage of IPF-related mortality as the non-ACEi/ARB group (3.6% vs 3.6%). In contrast, patients in the ARB group had greater risk of all-cause mortality (HR, 2.5 [95% CI, 1.2-5.2]). These observations were validated in a pooled analysis that included patients from the INSPIRE trial. - Conclusions - Prospective clinical trials are needed to evaluate whether angiotensin modulators may be beneficial to clinical outcomes in IPF. - Trial Registry - ClinicalTrials.gov; Nos.: NCT01366209, NCT00287716, NCT00287729, NCT00075998; URL: www.clinicaltrials.gov).