Sex-Specific Phenotypes and Outcomes in Non-Idiopathic Pulmonary Fibrosis Interstitial Lung Disease: Results from the INSIGHTS-ILD Registry.
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Koschel Dirk, Bonella Francesco, Günther Andreas, Kreuter Michael, Pittrow David, Seeliger Benjamin, Pausch Christine, Skowasch Dirk, Wilkens Heinrike, Wirtz Hubert, Hechtner Marlene, Biller Heike, Prasse Antje, Grohé Christian, Hagmeyer Lars, Budweiser Stephan, Andreica Ioana, Neff Ulrich, Gläser Sven, Schwaiblmair Martin, Schramm Peter, Meyer Joachim, Veit Tobias, Frankenberger Marion, Gesierich Wolfgang, Seese Bernd, Grünewaldt Achim, Markart Philipp, Westhoff Michael, Held Matthias, Kirschner Joachim, Wälscher Julia, Eisenmann Stephan, Walterspacher Stephan, Neurohr Claus, Kreutz Claus-Peter, Grund Daniel, Haberl Sabine, Ewert Ralf, Stubbe Beate, Polke Markus, Reichenberger Frank, von Wulffen Werner, Krauss Ekaterina, Weber Michael, Koch Elaine, Dreher Michael, Oqueka Tim, Malfertheiner Maximilian, Witte Torsten, Aringer Martin, Behr Jürgen
Аннотация
METHODS: In the prospective INSIGHTS-ILD registry (data cut 17 September 2025), we compared men and women with non-IPF ILD using descriptive analyses and Cox models with prespecified adjustment steps: model A (age, comorbidity count, and smoking), model B (A + forced vital capacity [FVC] and diffusing capacity of the lung for carbon monoxide [DLCO]), and model C (B + antifibrotic therapy). Prespecified subgroup analyses included age strata (≤55 and >55 years) and ILD entities. Longitudinal FVC and DLCO trajectories were assessed over 24 months.
RESULTS: Among 883 patients (483 men and 400 women), exposures and disease entities differed significantly by sex: men reported more occupational/environmental exposures and had higher rates of fibrotic idiopathic interstitial pneumonia, whereas women more frequently had autoimmune-related ILD and a family history of ILD. Men had a higher comorbidity burden and more often received antifibrotic therapy at baseline. Survival was shorter in men (HR: 1.51; 95% CI: 1.03-2.21), but this association disappeared after adjustment in model A (HR: 1.04; 95% CI: 0.65-1.68), model B (HR: 1.03; 95% CI: 0.61-1.74), and model C (HR: 1.04; 95% CI: 0.62-1.77). Progression-free survival and transplant-free survival showed no consistent sex-related differences. Longitudinal FVC and DLCO declines were modest and largely parallel in both sexes, with no significant between-group differences. Findings were similar across age groups and ILD entities.
CONCLUSION: Men and women with non-IPF ILD differ in exposures, phenotypes, and comorbidities, but after accounting for these factors, sex is not an independent predictor of survival or functional progression. Risk assessment should therefore primarily be based on objective disease characteristics rather than sex alone.