MedicalResearch.com Interview with:
Prof Michael Kreuter
Center for Interstitial and Rare Lung Diseases,
Pneumology and Respiratory Critical Care Medicine,
Thoraxklinik, University of Heidelberg and Translational Lung Research Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Prof. Kreuter: Already in the 70s, early reports hypothesized a relationship between gastroesophageal reflux disease (GERD) and pulmonary fibrosis (IPF). Since then, clinical and preclinical data suggested that micro-aspirations cause lung parenchymal injuries which may stimulate pulmonary fibrosis.
The hypothesis of a potential relationship between idiopathic pulmonary fibrosis (IPF_ and GERD also provoked the question of an effect of GERD-treatment by antacid therapy (i.e. proton pump inhibitors or H2-blockers) on the course of IPF. In this context, two analyses, one retrospective and one post hoc, reported that antacid treatment had positive effects on the course of pulmonary function and on survival in IPF patients. These data lead to a conditional recommendation for the treatment of patients with IPF with antacid therapy in the current international IPF guideline.
However, the low confidence in estimates of the effect prompted us to initiate a new post-hoc analysis pooling data from the placebo arms of three multinational trials on pirfenidone in interstitial pulmonary fibrosis. In this new analysis, published in Lancet Respiratory Medicine, antacid therapy was not associated with a slower disease progression in IPF. Moreover, in patients with advanced disease antacid therapy was associated with a significantly higher incidence of pulmonary and non-pulmonary infections.
MedicalResearch.com: What should clinicians and patients take away from your report?
Prof. Kreuter: Our new findings do not support the recommendation for antacid therapy for all patients with IPF.
Although physicians may reasonably offer antacid therapy to patients with IPF suffering from symptomatic gastro-oesophageal reflux disease our data do not suggest a beneficial treatment effect when given as a treatment for interstitial pulmonary fibrosis.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Prof. Kreuter: The discrepancies between our and other data underline the urgent need for long-term, randomized, placebo-controlled studies to investigate the effect of antacid therapy in patients with idiopathic pulmonary fibrosis, particularly in those with advanced disease.
MedicalResearch.com: Is there anything else you would like to add?
Prof. Kreuter: Comorbidities have a significant impact on symptoms and on prognosis o fidiopathic pulmonary fibrosis patients, which was underlined by further work we have published recently (Kreuter et al. PlosONE 2016). A future aim in IPF should therefore be to investigate how treatments of comorbidities impact the course of the disease.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Antacid therapy and disease outcomes in idiopathic pulmonary fibrosis: a pooled analysis
Kreuter, Michael et al.
The Lancet Respiratory Medicine , Volume 0 , Issue 0 ,
Published Online:31 March 2016
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Prof Michael Kreuter (2016). New Study Does Not Support Antacids for All Patients With IPF MedicalResearch.com