HRCT in Idiopathic Pulmonary Fibrosis: Diagnosis and Prognosis

1
HRCT in Idiopathic Pulmonary Fibrosis Diagnosis
and Prognosis

• Analysis of HRCT scans from patients enrolled in
  a randomized study of IFN g (n 315)
• Core panel of 3 thoracic radiologists conducted
  blinded reviews of baseline HRCT scans originally
  read by study site radiologists
• HRCT diagnoses of core panel compared with those
  of study site radiologists
• Baseline clinical, physiologic, and HRCT findings
  evaluated to identify predictors of mortality

Lynch DA. Am J Respir Crit Care Med.
2005172488-493. Click above link for abstract
2
Imaging Diagnosis of IPF Core Radiologists
Diagnosis of first 2 readers Consensus diagnosis
Consistent with IPF 256 (81.3) 283 (89.9)
Inconsistent with IPF 15 (4.8) 30 (9.5)
Lack of agreement 44 (14) 2 (0.6)
Lynch DA. Am J Respir Crit Care Med.
2005172488-493. Click above link for abstract
3
Likelihood of MortalityMultivariate Analysis of
Baseline Risk Factors
Baseline Risk Factor Hazard Ratio (95 Cl) P-value
HRCT overall disease extent score 2.71 (1.614.55) lt 0.0001
Baseline predicted DLCO 0.94 (0.900.98) 0.004
Randomization assignment to IFN g-1b 0.53 (0.280.99) 0.04
The P-value is from the Wald chi-square test,
stratifying by smoking status The ratio is
calculated by Cox proportional hazards model,
stratifying by smoking status
Lynch DA. Am J Respir Crit Care Med.
2005172488-493. Click above link for abstract
4
IFN g-1b Therapy in IPF A Meta-analysisIncluded
Studies
Source Active Treatment n Control Treatment n Follow-up (years) HR
Ziesche, et al IFN g-1b 200 ?g TIW 9 Placebo 9 5 0.1796
Antoniou, et al IFN g-1b 200 ?g TIW Prednisolone 10 mg QD 27 Colchicine Prednisolone 10 mg QD 15 1.5 0.1618
Raghu, et al IFN g-1b 200 ?g TIW Prednisolone 7.5 mg QD 162 Colchicine Prednisolone 7.5 mg QD 168 1.5 0.5898
Bajwa EK, et al. Chest. 2005128203-206. Click
above link for abstract
5
Effect of IFN g-1b Treatment on Survival
Raghu, et al. 2004
Antoniou, et al. 2003
Ziesche, et al. 2002
Pooled result
-8
-6
-4
-2
2
4
0
6
8
Natural Log of Hazard Ratio
Pooled Hazard Ratio 0.418 (0.2530.690) P
0.0003
Bajwa EK, et al. Chest. 2005128203-206. Click
above link for abstract
6
Effect of IFN g-1b Treatment on Survival
Hazard Ratio (95 CI) P-value
6 months 0.0046 (-0.03640.0456) 0.82
12 months 0.0861 (0.02440.1478) lt 0.0063
18 months 0.1682 (0.10650.2299) lt 0.0001
24 months 0.2652 (0.16520.3652) lt 0.0001
Bajwa EK, et al. Chest. 2005128203-206. Click
above link for abstract