Sex Differences in IPF: Data from the German INSIGHTS Registry

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) preferentially occurs in male patients and controversial results in gender-specific differences including overall mortality have been reported. METHODS: The INSIGHTS-IPF registry was a non-interventional, prospective cohort study including IPF patients from 20 interstitial lung disease expert centers in Germany. Sex-related disparities were analyzed regarding comorbidities, clinical course, and survival. RESULTS: Of the 1,043 IPF patients included, 842 (80.7%) were male and 201 (19.3%) were female. Male patients were more likely to have a history of smoking (p < 0.001) and environmental exposure, especially metal dust, wood dust, and solvents (p = 0.032). While males at baseline had a higher prevalence of coronary artery disease, atrial fibrillation, emphysema, and obstructive sleep apnea syndrome, in females, gastro-esophageal reflux disease and depression or depressive disorders were more frequent. Female IPF patients had more frequently a history of immunosuppressive therapy (p = 0.003). Regardless of gender, the INSIGHTS-IPF cohort as a whole showed a progressive worsening of lung function parameters over time. All-cause mortality did not differ between females and males (HR: 0.81; 95% CI: 0.63-1.04; p = 0.093) and female gender was not a significant predictor for mortality in IPF (HR 0.74; 95% CI: 0.54-1.03; p = 0.071). Interestingly, the GAP score underestimated the observed 2-year and 3-year mortality in females in GAP stage II. CONCLUSION: In the German INSIGHTS-IPF registry, no differences in lung function decline and survival could be observed between female and male patients with IPF, indicating differences between IPF cohorts from the USA and Europe.