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A systematic review of prognostic biomarkers in idiopathic pulmonary fibrosis

A systematic review of prognostic biomarkers in idiopathic pulmonary fibrosis

Prof Gisli Jenkins

University of Nottingham

29 July 2020

Idiopathic pulmonary fibrosis (IPF) is a devastating condition which causes scarring of the lungs and affects around 3 million people worldwide. Symptoms associated with IPF include shortness of breath, cough, reduced ability to exercise and an eventual need for home oxygen. The average survival from diagnosis is only around 3 years, however disease trajectory is variable, with some patients progressing much quicker than others. Identifying patients at the point of diagnosis who are likely to have "progressive disease" is important. This enables relevant therapies to be offered at an early stage, including lung transplantation, and the recently licensed antifibrotic drugs, which are not without their side effects. However, current methods of identifying "progressive disease" at the point of diagnosis have a number of limitations. Therefore, blood biomarkers, defined as proteins in the blood that indicate underlying biological processes, are currently under investigation for predicting survival and the progression of IPF. Biomarkers have the potential advantage of being easy to measure, objective and reproducible. In the past decade, a number of studies have been published worldwide looking at the utility of blood biomarkers in IPF. However, many of these studies are in small groups of patients, limiting their applicability to the wider population. Collating all this data in a "systematic review" would have the potential to better inform healthcare professionals. To our knowledge, no one has yet attempted this, and therefore our research team are hoping to carry out a robust study to appraise the existing literature around biomarkers in IPF. Following an initial search, there appears to be most data for MMP-7 (matrix metalloproteinase 7), so we hope to synthesise the data around this biomarker and perform a "meta analysis" to help validate this test in clinical practice.

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Statistical Analysis Plan

Fasihul A. Khan, Iain Stewart, Gauri Saini, Karen A. Robinson, R. Gisli Jenkins; A systematic review of blood biomarkers with individual participant data meta-analysis of matrix-metalloproteinase-7 in IPF; European Respiratory Journal (2021)