Association between weight loss and decline in FVC in patients with IPF

Introduction Weight loss has been associated with worse survival in patients with idiopathic pulmonary fibrosis (IPF). Aim To assess the association between weight loss and disease progression measured as decline in forced vital capacity (FVC) in patients with IPF in the INPULSIS trials. Methods In post-hoc analyses, we assessed the rate of decline in FVC (mL/yr) over 52 weeks in subgroups by weight loss from baseline over 52 weeks (weight gain/no weight loss; 0 to ≤ 5% weight loss; > 5 to ≤ 10% weight loss; > 10% weight loss) using random coefficient regression. Results Among 421 patients in the placebo group, the proportions with no, 0 to ≤ 5%, > 5 to ≤ 10% and > 10% weight loss over 52 weeks were 45.6%, 34.7%, 13.1% and 6.7%, respectively. At baseline, subgroups with greater weight loss over 52 weeks had a higher mean age, lower proportion of males, lower mean DLco % predicted and lower mean FVC % predicted. In the placebo group, the mean rate of decline in FVC over 52 weeks increased with increasing weight loss ([Fig. 1]). In contrast, similar rates of decline in FVC were observed in nintedanib-treated patients (n = 635) irrespective of weight loss. Conclusion In the INPULSIS trials, patients with greater weight loss showed faster disease progression when treated with placebo, and a more pronounced treatment effect of nintedanib.