Earlier detection of ILD progression with remote monitoring
Monitoring of progression is central to the management of ILD, determining appropriate treatment decisions along the course of the disease. In both clinical trials and clinical practice FVC is used as a key marker of disease progression, with FVC decline over 12 months and 6 months previously shown to be correlated with patient mortality.
A meta-analysis from IPF clinical trials, just published by Kahn and colleagues in the American Journal of Respiratory and Critical Care Medicine, now indicates that 3 month changes in FVC are associated with mortality in IPF, and are predictive of disease progression. The authors conclude that 3 month FVC decline could serve as an attractive surrogate end-point for clinical trials, enabling efficacy assessments of new therapies to be conducted in shorter time-frames.
At patientMpower we have also been considering the implications of this data for clinical practice, and the role of more frequent spirometry in the optimal management of patients with ILDs. But given capacity challenges for pulmonary function labs, three-monthly hospital-based spirometry is probably out of reach for most ILD centres, at least for the vast majority of their patients. More frequent clinic spirometry also introduces an additional burden on patients, often requiring long journeys and sometimes causing distress for those with a higher symptom burden.
None-the-less, more frequent assessment of disease progression may be clinically valuable in optimising patient-care, enabling earlier initiation of anti-fibrotic treatment for progressive ILDs for example, or prioritisation of patients for lung transplantation or other interventions. Remote monitoring can play a key role here, enabling clinicians to access frequent home spirometry data without the challenges of patient access and clinic capacity. Indeed, data from Russell et al showed that daily home spirometry was highly clinically informative in patients with IPF. Home spirometry data was highly predictive of disease outcomes as early as three months, with greater sensitivity than hospital-based readings.
The patientMpower platform captures more than just home spirometry, however, with patient recorded symptom data, oxygen saturation data, activity and more enabling a more holistic picture of a patient’s status. Feedback from centres using our technology is that this is highly valuable in a patient-centred approach, with the introduction of interventions such as pharmacotherapy or supplemental oxygen determined by patient need and not clinic review schedules, and leading to earlier transplant assessment or transplant re-prioritisation in some cases.
Want to learn more about our platform capabilities and how patientMpower can support earlier identification of progression? We’ll be exhibiting at ATS2022 this May! Come and see us at booth 606 in the exhibition hall, or to meet with us anytime over the conference use the link below to book a time.
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