Recombinant human soluble thrombomodulin for acute exacerbation of idiopathic pulmonary fibrosis: a nationwide observational study

Author:

Awano NobuyasuORCID,Jo Taisuke,Izumo Takehiro,Inomata Minoru,Morita Kojiro,Matsui Hiroki,Fushimi Kiyohide,Urushiyama Hirokazu,Nagase Takahide,Yasunaga Hideo

Abstract

Abstract Background Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is the leading cause of death among patients with IPF. However, there is no established treatment for this condition. Hence, we aimed to investigate the effectiveness and safety of recombinant human soluble thrombomodulin (rTM) for the treatment of AE-IPF. Methods Data were retrospectively collected from the Japanese Diagnosis Procedure Combination database from 1 January 2014 to 31 March 2018. We identified adult patients with IPF who received high-dose methylprednisolone (mPSL) therapy and mechanical ventilation upon admission. Eligible patients (n = 2814) were divided into those receiving high-dose mPSL alone (mPSL alone group, n = 2602) and rTM combined with high-dose mPSL (rTM group, n = 212). A stabilised inverse probability of treatment weighting (IPTW) using propensity scores was performed to compare outcomes between the two groups. The primary outcome was in-hospital mortality, and the secondary outcomes were 14- and 28-day mortality, bleeding events and length of hospital stay. Results The in-hospital mortality rates of the mPSL alone and rTM groups were 75.9% and 76.9%, respectively. The results did not significantly differ between the two groups after performing a stabilised IPTW. The odds ratio of the rTM group compared to the mPSL alone group was 1.15 (95% confidence interval: 0.71–1.84; p = 0.57). Moreover, the secondary outcomes did not differ significantly between the two groups. Conclusions In patients with AE-IPF who developed severe respiratory failure, rTM in addition to high-dose mPSL was not associated with a better outcome.

Funder

the Ministry of Health, Labour and Welfare, Japan

the Ministry of Education, Culture, Sports, Science and Technology, Japan

Publisher

Springer Science and Business Media LLC

Subject

Critical Care and Intensive Care Medicine

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