Comment on: Survival and course of lung function in the presence or absence of antifibrotic treatment in patients with idiopathic pulmonary fibrosis

With great interest I recently read the observations of the INSIGHTS-IPF registry published in the August 2020 issue of the European Respiratory Journal [1]. However, the paper represents an instructive example of how peer review occasionally may fail to prevent publication of unfounded conclusions. Though lead-time bias is mentioned as a potential limitation of the study in the discussion (possibly following peer review) and though lead-time bias is evident looking at the published data, the authors conclude that their study shows a significantly lower all-cause mortality in IPF patients with antifibrotic therapy, and that withholding antifibrotic therapy from stable IPF patients may set these patients on a path of increased risk of dying. This is an audacious conclusion given the fact that their data do not show any benefit of antifibrotic therapy, to begin with no slower forced vital capacity decline. Table 1 of the article, which lacks a column showing the statistical significance of differences between untreated and treated patients, demonstrates that while age at diagnosis was similar between the groups (68.1 and 68.0 years, respectively), age at inclusion was different (70.3 and 69.2 years, respectively). That is, patients treated with antifibrotics were included about 1 year earlier than untreated patients. In figure 2, consequently, the part of the Kaplan–Meier survival curve for patients with antifibrotic therapy to be compared with the survival...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Original Articles: Correspondence Source Type: research