Real-world experience of nintedanib for progressive fibrosing interstitial lung disease in the UK

Background Nintedanib slows progression of lung function decline in patients with progressive fibrosing (PF) interstitial lung disease (ILD) and was recommended for this indication within the United Kingdom (UK) National Health Service in Scotland in June 2021 and in England, Wales and Northern Ireland in November 2021. To date, there has been no national evaluation of the use of nintedanib for PF-ILD in a real-world setting.Methods 26 UK centres were invited to take part in a national service evaluation between 17 November 2021 and 30 September 2022. Summary data regarding underlying diagnosis, pulmonary function tests, diagnostic criteria, radiological appearance, concurrent immunosuppressive therapy and drug tolerability were collected via electronic survey.Results 24 UK prescribing centres responded to the service evaluation invitation. Between 17 November 2021 and 30 September 2022, 1120 patients received a multidisciplinary team recommendation to commence nintedanib for PF-ILD. The most common underlying diagnoses were hypersensitivity pneumonitis (298 out of 1120, 26.6%), connective tissue disease associated ILD (197 out of 1120, 17.6%), rheumatoid arthritis associated ILD (180 out of 1120, 16.0%), idiopathic nonspecific interstitial pneumonia (125 out of 1120, 11.1%) and unclassifiable ILD (100 out of 1120, 8.9%). Of these, 54.4% (609 out of 1120) were receiving concomitant corticosteroids, 355 (31.7%) out of 1120 were receiving concomitant mycophenolate mofetil and 340 (30.3%) out of 1120 were receiving another immunosuppressive/modulatory therapy. Radiological progression of ILD combined with worsening respiratory symptoms was the most common reason for the diagnosis of PF-ILD.Conclusion We have demonstrated the use of nintedanib for the treatment of PF-ILD across a broad range of underlying conditions. Nintedanib is frequently co-prescribed alongside immunosuppressive and immunomodulatory therapy. The use of nintedanib for the treatment of PF-ILD has demonstrated acceptable tolerability in a real-world setting

PTH-54 An Audit on the Use of Large Volume Paracentesis Checklist in Patients with cirrhosis

Introduction Standardised procedure checklist for large volume paracentesis (LVP) has been shown to improve rates of documentation and reduce procedure related complications (Fyson et al; 2018). A modified LVP checklist from the British Society of Gastroenterology was implemented at Exeter Hospital in September 2019 as a patient-safety measure. An audit pre and post checklist was conducted to assess uptake and outcomes.Methods 48 patients with ascites due to decompensated cirrhosis who had LVP were reviewed retrospectively through case note interrogation (24 pre- and 24 post-LVP checklist introduction). Malignant ascites was excluded. Patient demographics, procedure documentation and outcomes were collected. Data was analysed using SPSS. The chi-square test and Fisher’s exact value were used to compare percentages between groups.Results The patient characteristics in both groups are shown in Table 1. The majority of patients had alcohol-related cirrhosis (71% in both groups). About 2/3 cases in both groups were acute inpatient procedures. Documentation of informed consent using consent forms improved significantly from 8% pre-checklist to 63% (p=0.0002). Other areas of improvement included: procedural documentation of aseptic technique use (67% to 92%, p=0.07), instrument used (29% to 83%, p<0.0001) and drain removal at 6 hours (67% to 88%, p=0.168). Post-drain removal instructions documentation worsened from 54% (pre) to 42% (post). Documentation of fluid polymorph count only occurred in 3 (13%) pre- and 9 (38%) post-checklist (p=0.093). Complications within 24 hours were minor; hypotension and minor bleeding in pre- and abdominal pain in post-checklist group (p=1.00). No patients developed spontaneous bacterial peritonitis or died within 28 days. Overall mortality was 5 (21%) and 4 (17%) in the pre- and post-checklist group (p=1.00).View this table:Abstract PTH-54 Table 1 Patient characteristicsConclusions The LVP checklist resulted in overall improvement in documentation with significant improvement of documenting procedural informed consent. The complication rate was low with no mortality within 28-days. Post-drain removal instructions and documentation of ascitic fluid results require improvement. Increasing awareness on the importance of these sections in minimal standards of care amongst doctors and nurses will be the key factor in ensuring continual improvement in the quality of patient care.The article is available via Open Access. Click on the 'Additional link' above to access the full-text.Published version, accepted version, submitted versio

Real world experience of nintedanib for progressive fibrosing interstitial lung disease in the UK

Background Nintedanib slows progression of lung function decline in patients with progressive fibrosing interstitial lung disease (PF-ILD) and was recommended for this indication within the NHS in Scotland in June 2021 and in England, Wales and Northern Ireland in November 2021. To date there has been no national evaluation of the use of nintedanib for PF-ILD in a real-world setting. Methods Twenty-six UK centres were invited to take part in a national service evaluation between 17/11/21 and 30/09/22. Summary data regarding underlying diagnosis, pulmonary function tests, diagnostic criteria, radiological appearance, concurrent immunosuppressive therapy and drug tolerability was collected via electronic survey. Results Twenty-four UK prescribing centres responded to the service evaluation invitation. Between 17/11/2021 and 30/09/2022, 1120 patients received a multi-disciplinary team recommendation to commence nintedanib for PF-ILD. The most common underlying diagnoses were hypersensitivity pneumonitis (298/1120,26.6%), connective tissue disease associated interstitial lung disease (197/1120,17.6%), rheumatoid arthritis associated ILD (180/1120,16.0%), idiopathic non-specific interstitial pneumonia (125/1120,11.1%) and unclassifiable ILD (100/1120,8.9%). Of these, 54.4% (609/1120) were receiving concomitant corticosteroids, 355/1120 (31.7%) were receiving concomitant mycophenolate mofetil and 340/1120 (30.3%) were receiving another immunosuppressive/modulatory therapy. Radiological progression of ILD combined with worsening respiratory symptoms was the most common reason for the diagnosis of PF-ILD. Conclusion We have demonstrated the use of nintedanib for the treatment of PFILD across a broad range of underlying conditions. Nintedanib is frequently co-prescribed alongside immunosuppressive and immunomodulatory therapy. The use of nintedanib for the treatment of PF-ILD has demonstrated acceptable tolerability in a real-world setting