Effect Of Anti-Fibrotic Therapy On Psychological Status Of Patients With Idiopathic Pulmonary Fibrosis

Research background and purpose:Idiopathic pulmonary fibrosis(IPF)is a progressive chronic lung disease characterized by refractory cough,dyspnea,decreased lung function,and deterioration of quality of life.Antifibrotic drugs can slow disease progression and improve prognosis to some extent,but their effects on the psychosomatic status of patients are still unclear.To investigate the changes of mental state and related factors in patients with idiopathic pulmonary fibrosis(IPF)before and after treatment with the anti-fibrosis drug nintedanib,and to provide more evidence of clinical benefits for the chronic disease management of IFP and the initiation of anti-fibrosis decision-making.Materials and Methods:Patients with IPF diagnosed in the outpatient and inpatient departments of the Department of Pulmonary and Critical Care Medicine,Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital from September 2021 to November2022 were prospectively enrolled.Demographic data and clinical characteristics,psychosomatic scale scores 7-item generalized anxiety disorder scale(GAD-7),9-item patient health questionnaire(PHQ-9),15-item Somatic Symptom Health questionnaire(PHQ-15),activity of daily Living scale(ADL),St George’s respiratory questionnaire(SGRQ),6-minute walk test(6MWD),Borg scale were collected;The related factors of anxiety and depression in IPF patients were analyzed.The efficacy and adverse reactions of nintedanib treatment were collected,and the related factors of symptom relief were also evaluated.Result:1.A total of 56 patients with IPF were enrolled in this study with an average age of65.6 years and a median disease duration of 18 months.64.3% among those had smoking history,51.8% had chronic cough and 44.6% had dyspnea.Gastroesophageal reflux disease was the major comorbidity in this cohort.2.In IPF patients,GAD-7 score was negatively correlated with low education,low household income and 6MWD;PHQ-9 score was negatively correlated with smoking,low education,6MWD and DLCO%;and GAD-7 and PHQ-9 scores were positively correlated with PHQ-15,ADL and SGRQ-T scores.3.Binary logistc regression analysis showed that SGRQ-T was independent predictors of IPF complicated with anxiety,and the AUC was 0.799.The sensitivity and specificity were 92.9% and 64.3%,respectively.SGRQ-T was also an independent predictor of IPF complicated with depression,and the AUC was 0.799.The sensitivity and specificity were 57.1% and 95.2%,respectively.4.After antifibrotic therapy,seven patients were admitted to the hospital for an acute exacerbation,which was the most common risk event in our study.Among all observed adverse reactions,16 patients had weight loss,15 patients had decreased appetite,8 patients had diarrhea,and no patient had abnormal elevation of transaminase.The GAD-7,PHQ-9 and PHQ-15 scores of the patients were significantly lower than those before treatment,and the clinical symptoms of 35 patients were relieved after treatment.Symptom relief was significantly negatively correlated with GAD-7 score,the change of GAD-7 before and after treatment(ΔGAD-7),PHQ-9 score after treatment,PHQ-15 score after treatment,and ADL score before and after treatment.Conclusion:1.IPF patients have different degrees of anxiety,depression and somatic symptoms,accompanied by the decline of lung function and quality of life,which could be significantly improved after nintedanib anti-fibrosis treatment.2.SGRQ-T score is an independent predictor of IPF patients with anxiety and depression,which has a high predictive value3.Acute exacerbation hospitalization is the main risk event in short term of IPF,Weight loss,lack of appetite and diarrhea are common adverse drug reactions.Symptom relief is closely related to the improvement of psychosomatic scale scores as well as heart and lung function.