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An updated approach to determine minimal clinically important differences in idiopathic pulmonary fibrosis

Mohleen Kang, Srihari Veeraraghavan, Greg S. Martin, Jordan A. Kempker
ERJ Open Research 2021 7: 00142-2021; DOI: 10.1183/23120541.00142-2021
Mohleen Kang
Emory University School of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, GA, USA
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  • ORCID record for Mohleen Kang
  • For correspondence: mkang30@emory.edu
Srihari Veeraraghavan
Emory University School of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, GA, USA
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Greg S. Martin
Emory University School of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, GA, USA
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Jordan A. Kempker
Emory University School of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Atlanta, GA, USA
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Tables

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  • TABLE 1

    Change in measures that met responsiveness criteria over 24 weeks by health transition question (SF2) categorical responses in patients with idiopathic pulmonary fibrosis in the Sildenafil Trial of Exercise Performance in Idiopathic Pulmonary Fibrosis (STEP-IPF) trial

    SF2 response at 24-week follow-upAUC (95% CI)¶
    Much betterSomewhat betterAbout the sameSomewhat worse#Much worse
    Subjects n71246589
    Physiological measures
     Δ6MWD m−3.71±42.33−35.08±144.51−32.29±95.46−74.89±69.32−163.00±122.930.72 (0.61–0.83)

    Data are presented as mean±sd, unless otherwise stated. AUC: area under the curve; Δ: absolute change over 24 weeks; 6MWD: 6-min walk distance. #: the mean change in scores in the “somewhat worse” category is the minimal clinically important difference value for measures that meet the responsiveness criteria; ¶: receiver operating curve comparing dichotomous health transition question (SF2) response (“about the same” versus “somewhat worse”) with mean change score of variable.

    • TABLE 2

      Change in measures that met responsiveness criteria over 60 weeks by health transition question (SF2) categorical responses in patients with idiopathic pulmonary fibrosis in the Prednisone, Azathioprine, and N-Acetylcysteine: A Study That Evaluates Response in Idiopathic Pulmonary Fibrosis (PANTHER-IPF) trial

      SF2 response at 60-week follow-upAUC (95% CI)¶
      Much betterSomewhat betterAbout the sameSomewhat worse#Much worse
      Subjects n11321017410
      Physiological measures
       ΔSF-36 physical component score+8.00±11.57−0.92±6.26−0.06±5.72−6.79±8.07−5.29±9.260.75 (0.67–0.83)
      Subjective measures
       ΔTotal SGRQ score§−13.70±14.55−0.97±9.601.35±9.1810.95±13.1925.86±17.460.71 (0.63–0.79)
       ΔUCSD SOBQ total score−4.45±11.793.19±9.600.59±12.8111.38±15.3134.90±23.650.72 (0.65–0.80)

      Data are presented as mean±sd, unless otherwise stated. AUC: area under the curve; Δ: absolute change over 60 weeks; SF-36: 36-Item Short-Form Health Survey; SGRQ: St George's Respiratory Questionnaire; UCSD SOBQ: University of California, San Diego Shortness of Breath Questionnaire. #: the mean change in scores in the “somewhat worse” category is the minimal clinically important difference value for measures that meet the responsiveness criteria; ¶: receiver operating curve comparing dichotomous health transition question (SF2) response (“about the same” versus “somewhat worse”) with mean change score of variable; +: missing n=5 (0 “much better”, 1 “somewhat better”, 4 “about the same”, 0 “somewhat worse”, 0 “much worse”); §: missing n=13 (0 “much better”, 2 “somewhat better”, 8 “about the same”, 3 “somewhat worse”, 0 “much worse”).

      • TABLE 3

        Anchor-based estimates of minimal clinically important difference (MCID) for worsening in idiopathic pulmonary fibrosis from current study and comparison with MCID estimates from previous studies

        Current MCID estimatePrevious MCID estimate#
        Time period¶MCID+ (95% CI)Time period [ref.]MCID
        6MWD m24 weeks−74.89 (−93.11– −56.66)48 weeks [14]24–45§
        48 weeks [16]21.7 –37.0§
        52 weeks [11]28
        SF-36 physical component score60 weeks−6.79 (−8.66– −4.92)26 weeks [13]3
        No specified time period [10]5
        Total SGRQ score60 weeks10.95 (7.81–14.1)26 weeks [13]7 (5–10)##
        52 weeks [12]4–5
        UCSD SOBQ total score60 weeks11.38 (7.83–14.93)24 weeks [19]8 (5–11)##

        6MWD: 6-min walk distance; SF-36: 36-Item Short-Form Health Survey; SGRQ: St George's Respiratory Questionnaire; UCSD SOBQ: University of California, San Diego Shortness of Breath Questionnaire. #: previous studies have estimated MCID values for worsening and improvement using both anchor-based and distribution-based methods; ¶: 6MWD met responsiveness criteria only in the Sildenafil Trial of Exercise Performance in Idiopathic Pulmonary Fibrosis (STEP-IPF) cohort, while the SF-36 physical component score, SGRQ and UCSD SOBQ met criteria in only the Prednisone, Azathioprine, and N-Acetylcysteine: A Study That Evaluates Response in Idiopathic Pulmonary Fibrosis (PANTHER-IPF) cohort; therefore, time period for MCID is 24 weeks or 60 weeks; +: MCID for worsening only, since it was calculated as mean change in “somewhat worse” health transition question (SF2) group from baseline to follow-up; §: range; ##: point estimate (range).

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        An updated approach to determine minimal clinically important differences in idiopathic pulmonary fibrosis
        Mohleen Kang, Srihari Veeraraghavan, Greg S. Martin, Jordan A. Kempker
        ERJ Open Research Oct 2021, 7 (4) 00142-2021; DOI: 10.1183/23120541.00142-2021

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        An updated approach to determine minimal clinically important differences in idiopathic pulmonary fibrosis
        Mohleen Kang, Srihari Veeraraghavan, Greg S. Martin, Jordan A. Kempker
        ERJ Open Research Oct 2021, 7 (4) 00142-2021; DOI: 10.1183/23120541.00142-2021
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