Published ahead of print on September 13, 2007, doi:10.1164/rccm.200702-181OC Am. J. Respir. Crit. Care Med., Volume 176, Number 11, December 2007, 1084-1089 A more recent version of this article appeared on December 1, 2007
Submitted on February 2, 2007 Clinical Use of Ibuprofen is Associated with Slower FEV1 Decline in Children with Cystic FibrosisMichael W Konstan1*,1 Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Rainbow Babies and Children's Hospital, Cleveland, OH, USA, 2 Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, OH, USA * To whom correspondence should be addressed. E-mail: michael.konstan{at}case.edu.
Rationale: High-dose ibuprofen in a 4-year controlled trial slowed FEV1 decline in young subjects with cystic fibrosis, but ibuprofen's effectiveness has not been assessed in a large group of patients treated clinically with this therapy. Objective: To assess the effect of ibuprofen therapy on FEV1 decline in children and adolescents with cystic fibrosis using observational data from the Cystic Fibrosis Foundation Patient Registry. Methods: The rate of decline in FEV1 % predicted over 2-7 years among patients age 6-17 years with FEV1 > 60% predicted who were treated with ibuprofen (1,365) was compared to patients of similar age and disease severity who were not treated with this therapy (8,960). Multilevel repeated-measures mixed-regression models were used to estimate rates of decline, adjusting for characteristics and therapies that influenced FEV1 decline. Adverse effects were compared among those treated versus not-treated with ibuprofen. Measurements and Main Results: FEV1 declined less rapidly among patients treated with ibuprofen (difference =0.60% predicted per year; 95% CI 0.31 to 0.89, p<0.0001); a 29% reduction in slope based on an average decline of 2.08 % predicted per year for patients not treated. Those treated with ibuprofen were more likely to have an episode of gastrointestinal bleeding requiring hospitalization, but the occurrence was rare in both groups (annual incidence 0.37% vs. 0.14%; relative risk 2.72, p<0.001). Conclusions: Slower rates of FEV1 decline are seen in children and adolescents with cystic fibrosis who are treated with ibuprofen. The apparent benefits of ibuprofen therapy outweigh the small risk of gastrointestinal bleeding. Key words: cystic fibrosis, ibuprofen, anti-inflammatory therapy, pulmonary function, epidemiology
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