CHEST Guidelines-Uncomfortable-Truths-About-Data,-Justice,-and-Idio

Uncomfortable-Truths-About-Data,-Justice,-and-Idio

Pdf Summary

The editorial by Brian W. Locke, MD, and Sean J. Callahan, MD, examines the low prescription rates and racial and rural disparities in the administration of antifibrotic treatments for idiopathic pulmonary fibrosis (IPF) in the Veterans Health Administration. Following the 2014 FDA approval of pirfenidone and nintedanib, which were based on the surrogate endpoint of reducing the rate of forced vital capacity (FVC) decline due to the dire prognosis of IPF, subsequent evidence has supported their effectiveness in reducing flare-ups and mortality. Despite recommendations for shared decision-making with patients on the use of antifibrotics, actual prescription rates are low. Specifically, only 21% of patients in a broad insurance plan analysis, and 17% in a Veterans Affairs study received antifibrotics. The study highlighted racial, gender, and geographic inequities, with women, Black participants, and rural patients significantly less likely to receive these medications. The editorial underscores the importance of ensuring all patients have access to informed guidance about antifibrotic treatments, acknowledging ethical obligations to improve IPF patient care, particularly for underrepresented and disadvantaged communities.<br /><br />The authors suggest that system-level issues should be scrutinized, particularly as the VA adds more community partners, and note that other factors besides medication costs are barriers in the case of the VA system, where co-pays were minimal. They strongly advocate for efforts to improve detection and treatment of IPF using real-world evidence to ensure equitable distribution of medical resources and interventions. The piece concludes with calls for further research and system improvement to address the noted disparities and enhance the integration of antifibrotic therapies in patient care protocols.

Keywords

idiopathic pulmonary fibrosis

antifibrotic treatments

racial disparities

rural disparities

Veterans Health Administration

pirfenidone

nintedanib

healthcare inequities

shared decision-making

system-level issues