Antifibrotic prescribing is changing significantly in the UK with new National Institute for Health and Care Excellence (NICE) guidelines for nintedanib prescribing in IPF set to be published in February 2023 (NICE, 2022). There are also inconsistencies in prescribing between patients with IPF and PF-ILD. 

Our aim was to evaluate discrepancies in anti-fibrotic availability for patients on a national IPF registry using current, future and PF-ILD UK prescribing criteria.

Permission was obtained from the British Thoracic Society (BTS) Information Governance Committee to access FVC readings for patients with IPF on the National BTS ILD registry. As of December 2022, 3,652 patients were on the registry. Of these, 987 had serial FVC readings. We compared anti-fibrotic eligibility in this cohort using three UK prescribing criteria; current NICE guidelines (FVC 50-80% predicted), new NICE guidelines (FVC ?50%) and PF-ILD criteria (?10% FVC decline in a 2 year period).

Based on first FVC results, 60.5% (n=2185) of patients met current NICE guidelines for antifibrotics. Using new NICE guidelines, 97.5% (n=3519) would be eligible, an increase of 36.9%. Of the patients with serial FVC results who were ineligible for antifibrotics based on current NICE guidelines, 109 met PF-ILD criteria for nintedanib (median FVC drop of 13.9% over 298 days).

There is significant variation in antifibrotic availability for patients depending on the prescribing criteria applied. Changes to current UK prescribing guidelines in IPF will significantly increase anti-fibrotic availability. This data highlights the need to upscale current UK ILD services.