{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:43:54Z","timestamp":1792691034758,"version":"4.5.0"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>For ten years, nintedanib and pirfenidone have been the only approved therapies for idiopathic pulmonary fibrosis (IPF), with nintedanib subsequently also approved for progressive pulmonary fibrosis (PPF). Previous studies demonstrate low antifibrotic (AF) uptake, but differences by site-of-care and AF uptake after seminal trials (IPF: INPULSIS\/ASCEND; PPF: INBUILD) are not well characterized. We evaluated temporal trends in IPF and PPF diagnosis and AF use at academic (AC) versus non-academic (NonAC) centers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the U.S. TriNetX Collaborative Network, we compared IPF and PPF incidence, prevalence, and AF use by center type using linear regression across post-trial and post\u2013FDA-approval windows (IPF: 2015\u20132017, 2015\u20132024; PPF: 2020\u20132022, 2020\u20132024). Slope differences (\u0394slope) were calculated as AC minus NonAC annual slopes; therefore, positive values indicate faster increases at ACs, whereas negative values indicate faster increases at NonACs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Across both periods, IPF prevalence increased more rapidly at NonACs, while AF use was higher at ACs (2024: 33.5% vs 20.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). During the post-approval period (2015\u20132024), AF initiation and overall use rose faster at ACs: (AC\u2013NonAC \u0394 slope +0.26 percentage points\/year, p\u2009=\u20090.002;\u2009+\u20091.25 percentage points\/year, p\u2009&lt;\u20090.001). During the post-INPULSIS\/ASCEND period (2015\u20132017), overall AF use rose faster at ACs (\u0394 slope +1.23 percentage points\/year, p\u2009=\u20090.009), while AF initiation slopes did not differ significantly (\u0394 slope \u22120.22 percentage points\/year,\n                      <jats:bold>p\u2009=\u20090.155<\/jats:bold>\n                      ). PPF prevalence was similar across centers, with higher AF use at ACs in 2024 (17.1% vs 9.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). During the post-approval period (2020\u20132024), AF initiation and overall AF use increased faster at ACs (\u0394slope +1.16 percentage points\/year,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001;\u2009+\u20091.94 percentage points\/year,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.009). During the post-INBUILD period (2020\u20132022), AF initiation rose faster at ACs (\u0394 slope +1.42 percentage points\/year, p\u2009=\u20090.002), while overall AF slope differences were not significant. Outcome patterns for IPF revealed higher mortality and lung transplant in ACs, but lower respiratory failure and oxygen use. PPF showed higher respiratory failure and mortality in ACs, and no significant differences in lung transplant or oxygen use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AF use in IPF and PPF was higher and rose faster at ACs, suggesting faster AC adoption and potential barriers at NonACs. Mixed outcome findings suggest referral and severity bias may partially explain differences, however, are unlikely to fully account for them. More research is needed to account for referral and severity bias. Given the small NonAC PPF cohort (n\u2009=\u2009216), PPF findings should be interpreted with caution.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360987","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:29:21Z","timestamp":1792690161000},"page":"e0360987","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Institutional patterns in diagnosis and antifibrotic-era treatment uptake for IPF and PPF across U.S. centers"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7491-9527","authenticated-orcid":true,"given":"Bradley A.","family":"Sheffield","sequence":"first","affiliation":[{"name":"Virginia Commonwealth University School of Medicine","place":["Richmond, Virginia, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian J.","family":"Cassel","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University","place":["Richmond, Virginia, United States of America"],"department":["Division of Hematology, Oncology and Palliative Care"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apostolos","family":"Perelas","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University","place":["Richmond, Virginia, United States of America"],"department":["Division of Pulmonary and Critical Care Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Sime","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University","place":["Richmond, Virginia, United States of America"],"department":["Division of Pulmonary and Critical Care Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Jackson","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University","place":["Richmond, Virginia, United States of America"],"department":["Division of Pulmonary and Critical Care Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"issue":"19","key":"pone.0360987.ref001","doi-asserted-by":"crossref","first-page":"1811","DOI":"10.1056\/NEJMra1705751","article-title":"Idiopathic pulmonary fibrosis","volume":"378","author":"DJ Lederer","year":"2018","journal-title":"N Engl J Med"},{"issue":"150","key":"pone.0360987.ref002","doi-asserted-by":"crossref","first-page":"180076","DOI":"10.1183\/16000617.0076-2018","article-title":"Presentation, diagnosis and clinical course of the spectrum of progressive-fibrosing interstitial lung diseases","volume":"27","author":"V Cottin","year":"2018","journal-title":"Eur Respir Rev"},{"issue":"6","key":"pone.0360987.ref003","first-page":"2000085","article-title":"The natural history of 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Vienna, Austria; 2024."},{"key":"pone.0360987.ref015","doi-asserted-by":"crossref","first-page":"14799731241299443","DOI":"10.1177\/14799731241299443","article-title":"Antifibrotic drug treatment of patients with idiopathic pulmonary fibrosis in Sweden: A registry-based observational study","volume":"21","author":"L Carlson","year":"2024","journal-title":"Chron Respir Dis"},{"key":"pone.0360987.ref016","doi-asserted-by":"crossref","first-page":"799912","DOI":"10.3389\/fmed.2022.799912","article-title":"Burden of progressive-fibrosing interstitial lung diseases: a claims-based study in the United States","volume":"9","author":"V Cottin","year":"2022","journal-title":"Front Med"},{"issue":"10","key":"pone.0360987.ref017","first-page":"1657","article-title":"Using administrative data to estimate the prevalence of progressive fibrosing interstitial lung disease in the United States","volume":"19","author":"E Petnak","year":"2022","journal-title":"Ann Am Thorac Soc"},{"issue":"4","key":"pone.0360987.ref018","doi-asserted-by":"crossref","DOI":"10.1016\/j.chest.2021.07.1163","article-title":"Community pulmonologist access to multidisciplinary discussion at an academic referral center leads to changes in management of interstitial lung disease","volume":"160","author":"C Streiler","year":"2021","journal-title":"Chest"},{"issue":"2","key":"pone.0360987.ref019","doi-asserted-by":"crossref","first-page":"00209","DOI":"10.1183\/23120541.00209-2018","article-title":"The characterisation of interstitial lung disease multidisciplinary team meetings: A global study","volume":"5","author":"L Richeldi","year":"2019","journal-title":"ERJ Open Research"},{"issue":"6","key":"pone.0360987.ref020","first-page":"560","article-title":"Incidence, prevalence, and clinical course of idiopathic pulmonary fibrosis among commercially insured U.S. adults aged <65 years","volume":"7","author":"ER Fern\u00e1ndez P\u00e9rez","year":"2010","journal-title":"Ann Am Thorac Soc"},{"issue":"2","key":"pone.0360987.ref021","article-title":"Idiopathic pulmonary fibrosis: State of the Art 2023","volume":"19","author":"T Koudstaal","year":"2023","journal-title":"Breathe (Sheff)"},{"key":"pone.0360987.ref022","first-page":"107207","article-title":"Idiopathic pulmonary fibrosis in older adults: Insights from Medicare data","volume":"211","author":"Y Wang","year":"2023","journal-title":"Respir Med"},{"issue":"4","key":"pone.0360987.ref023","first-page":"1312","article-title":"Epidemiology of idiopathic pulmonary fibrosis in US veterans: A population-based cohort study","volume":"160","author":"Y Zhang","year":"2021","journal-title":"Chest"},{"issue":"1","key":"pone.0360987.ref024","first-page":"321","article-title":"Prevalence of progressive fibrosing interstitial lung diseases in the United States","volume":"39","author":"M Singer","year":"2022","journal-title":"Adv Ther"},{"issue":"5","key":"pone.0360987.ref025","doi-asserted-by":"crossref","DOI":"10.1164\/rccm.201807-1255ST","article-title":"Diagnosis of idiopathic pulmonary fibrosis. An official ATS\/ERS\/JRS\/ALAT clinical practice guideline","volume":"198","author":"G Raghu","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"issue":"7","key":"pone.0360987.ref026","doi-asserted-by":"crossref","first-page":"4100","DOI":"10.1007\/s12325-021-01786-8","article-title":"Prevalence and incidence of chronic fibrosing interstitial lung diseases with a progressive phenotype in the United States estimated in a large claims database analysis","volume":"38","author":"AL Olson","year":"2021","journal-title":"Adv Ther"},{"key":"pone.0360987.ref027","volume-title":"Clinical policy: antifibrotic therapy for idiopathic pulmonary fibrosis and other interstitial lung diseases","author":"UnitedHealthcare","year":"2023"},{"key":"pone.0360987.ref028","volume-title":"Coverage policy: antifibrotic agents for idiopathic pulmonary fibrosis and other fibrosing interstitial lung diseases","year":"2023"},{"key":"pone.0360987.ref029","volume-title":"Antifibrotic therapy for pulmonary fibrosis: Coverage criteria and coding guidelines","author":"Cigna","year":"2023"},{"issue":"1","key":"pone.0360987.ref030","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1513\/AnnalsATS.202102-216OC","article-title":"Travel distance to subspecialty clinic and outcomes in patients with fibrotic interstitial lung disease","volume":"19","author":"KA Johannson","year":"2022","journal-title":"Ann Am Thorac Soc"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360987","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:29:26Z","timestamp":1792690166000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0360987"}},"subtitle":[],"editor":[{"given":"Bharat Bhushan","family":"Sharma","sequence":"first","affiliation":[{"name":"SMS Medical College and Hospital","place":["INDIA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,22]]},"references-count":30,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0360987","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,22]]}}}