Pharmacologic treatment for gastroesophageal reflux (GER) resulted in a significant reduction in idiopathic pulmonary fibrosis (IPF)-related mortality and improved transplant-free survival, according to the results of a meta-analysis published in CHEST.
GER is common in IPF, affecting up to 90% of patients, and some evidence has suggested that microaspiration may act as an inciting event for exacerbations, altering the natural history of the disease. However, a causal relationship between GER and IPF has not yet been confirmed.
Lee Fidler, MD, FRCPC, of the Department of Medicine, Division of Respirology, University Health Network in Toronto, Ontario, Canada, and colleagues performed a systematic review and meta-analysis using randomized and observational studies that evaluated the effects of pharmacologic or nonpharmacologic treatment for GER in patients with IPF. Primary outcomes were IPF-related mortality and all-cause mortality. The investigators evaluated the evidence according to GRADE methodology, and the study was registered with PROSPERO.
The investigators identified 13 observational studies, 8 of which they included in the meta-analysis. They found that pharmacologic treatment of GER was associated with a significant reduction in IPF-related mortality compared with no GER treatment (unadjusted risk, hazard ratio 0.60; 95% CI, 0.38-0.97; P =.04) but not all-cause mortality (unadjusted, hazard ratio R 0.73; 95% CI, 0.45-1.2; P =.22). However, the quality of evidence for these outcomes was low.
The authors noted that the primary limitation of the meta-analysis was that studies were all observational. Treatment effects from nonrandomized studies have an increased risk for bias and confounding. Another limitation is the risk for immortal time bias in several studies in which participants may have had to survive a certain length of time before the effect of treatment on survival could be analyzed. These limitations resulted in a low quality of evidence, and therefore, the results should be interpreted with caution.
The authors called for randomized controlled trials to elucidate the effects of GER treatment on health outcomes and adverse events in IPF.
Disclosures: Dr Shapera has served on advisory boards and participated in speaking engagements for Hoffman-LaRoche Canada, Boehringer-Ingelheim Canada, and AstraZeneca Canada. Dr Shapera has also participated in clinical trial research for Hoffman-LaRoche Canada, Boehringer-Ingelheim Canada, Prometic Pharmaceuticals, Gilead Pharmaceuticals, and Sanofi-Aventis Canada.
Fidler L, Sitzer N, Shapera S, Shah PS. Treatment of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis [published online March 17, 2018]. Chest. doi:10.1016/j.chest.2018.03.008