Women With ILD Fare Better After ICU Care
Women admitted to ICU for interstitial lung disease (ILD) had shorter hospital stays and a lower risk for death than men, based on a new analysis of more than 800,000 individuals.
Although previous studies have shown gender-based disparities in disease progression and severity for ILD based on subtype, data on the effect of gender on ICU outcomes in these patients are limited, according to Matthew Viggiano, MD, an internal medicine resident at Temple University Hospital, Philadelphia, and colleagues.
In a study presented at the American Thoracic Society (ATS) 2025 International Conference, the researchers analyzed data from the National Inpatient Sample (NIS), part of the Healthcare Cost and Utilization Project for the period from 2016 to 2018. They identified 810,295 adults aged 18 years or older hospitalized with ILD, of whom 42,080 received ICU care. Of these, 46.7% were women.
Female patients were significantly younger than male patients (mean age, 66.9 vs 69.1 years), more likely to be African American (17.0% vs 10.9%), and less likely to be Caucasian (63.7% vs 69.2%; P < .001 for all).
Mortality was significantly lower in women than in men (40.5% vs 48.1%) even after adjusting for confounders including age, race, and comorbidities, and this difference was the most striking finding, Viggiano said in an interview.
'It also surprised us that these women tended to have a shorter length of hospital stay, given many came from lower-income areas,' he said.
ICU stays were defined using International Classification of Diseases (ICD) codes for central line placement and mechanical ventilation. Overall, hospital stays for female patients lasted 1.15 days less than hospital stays for male patients.
Female patients also were significantly more likely than male patients to come from lower-income ZIP codes (38.3% vs 33.2%) and less likely to have a history of tobacco use disorder (35.0% vs 43.9%; P < .001 for both).
The reasons for the disparities remain unclear, but new studies suggest that hormones may play a role in disease progression and severity, Viggiano told Medscape Medical News . 'For example, estrogen has been implicated in modulating immune responses and fibrotic processes in the lungs via downregulating profibrotic pathways,' he said. 'Additionally, women may have lower threshold to seek medical attention or follow-up, leading to earlier intervention and management of ILD,' he noted. Other comorbidities unrelated to ILD also may contribute to morbidity and hospital length of stay, he added.
'Overall, recognizing these disparities is a key step toward more personalized treatment strategies, and our hope is that this research will prompt further studies to fully understand and address the underlying causes,' said Viggiano.
Not Time for Gender Neutral Treatments
Although the results suggest that clinicians should be aware that gender could influence ILD prognosis, the data do not suggest a need to advocate for entirely separate protocols as yet, Viggiano said. 'Instead, we encourage clinicians to recognize that men may have unique risk factors and might require more aggressive monitoring or early interventions; further studies will help refine specific management strategies,' he said.
'We believe evaluating for mortality and hospital stay in different subtypes of ILD would be an immediate future direction for the project,' said Viggiano. The investigation of specific biological, immunologic, and social factors also must be an area of focus, he said. 'Understanding why women fare better could lead to targeted therapies, especially for men who are at higher risk of poor outcomes, and ultimately to more personalized approaches to ILD care,' he added.
To that end, Viggiano and colleagues intend to conduct prospective studies to explore specific biological markers and social determinants in men and women with ILD. 'We'll also look at the influence of treatment interventions, medication use, and rehabilitation services on outcomes. Ultimately, we'd like to identify targeted strategies to reduce the mortality gap and enhance care for both genders,' he told Medscape Medical News .
Data Reinforce Differences
'As more treatments for interstitial lung diseases emerge, it is important that we now start focusing on which populations get the greatest benefit for specific treatments,' said Anthony Faugno, MD, a pulmonologist at Tufts Medicine, Boston, in an interview.
To that end, the authors of the current study used data from the NIS to ask important questions about how sex, demographics, and socioeconomic factors affect patient outcomes, said Faugno, who was not involved in the study.
Were You Surprised by Any of the Findings? Why or Why Not?
Biologically important differences in hormones between men and women are known to affect the way a given disease behaves; therefore, it is important to have representative samples of diverse sex and race in clinical trials to ensure the generalizability of therapy, Faugno told Medscape Medical News . The current study findings were not surprisingbut reinforce the value of a diverse population using a large, nationally representative sample, he said.
The current study findings may not directly affect clinical practice, as the results were based on ICD codes that cover many different diagnoses, Faugno noted. However, as the authors suggest, 'I do think it informs additional research directions, such as doing a similar analysis in specific interstitial diseases,' he said.
The current study addresses a global catch-all term of ILD, which may include many different pathologies that respond to different treatments, said Faugno. 'A future analysis that addressed the gender disparities in more specific diagnoses would add to our understanding and help patients better understand how they may respond to a specific therapy,' he said.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Business Upturn
3 days ago
- Business Upturn
Pulmonologists and Rheumatologists Struggle to Diagnose and Manage CTD-ILD, According to New Research from Spherix Global Insights
EXTON, PA, June 17, 2025 (GLOBE NEWSWIRE) — According to Spherix Global Insights' newly published Special Topix™: Interstitial Lung Disease in Rheumatology (US) report, both rheumatologists and pulmonologists report significant challenges in diagnosing and managing connective tissue disease-associated interstitial lung disease (CTD-ILD), with systemic sclerosis (SSc) and myositis (IIM) cited as the most difficult subtypes to treat. The research, based on responses from 138 US specialists (n=68 rheumatologists and 70 pulmonologists), highlights persistent unmet needs, diagnostic ambiguity, and a call for more robust and collaborative management strategies. The findings reflect that undiagnosed and misdiagnosed patients make up a substantial portion of the CTD-ILD population, with nearly one-third of rheumatologists and over half of pulmonologists naming differential diagnosis as a key challenge. Specialists underscore a lack of specific biomarkers, logistical biopsy issues, and overlapping symptoms as primary obstacles. 'The most definitive test (biopsy) is invasive. It is difficult to find the clinicians who are willing to do it in a timely manner, and to convince the patient it needs to be done.' – Rheumatologist 'Ensuring the correct diagnosis to avoid misdiagnosing the type of ILD or source of ILD. I usually employ the assistance of a rheumatologist.' – Pulmonologist 'Often it would be difficult to get patients biopsied for logistical reasons, and often the pathology report would not be precise enough.' – Pulmonologist Even once diagnosed, CTD-ILD patients face a treatment landscape with few options to slow or halt disease progression. When asked about the most difficult aspects of management, specialists consistently pointed to a lack of effective and targeted therapies, with SSc-ILD and myositis-ILD receiving the highest unmet need scores. For SSc-ILD specifically, not only is it associated with the most aggressive progression and worst long-term outcomes, but it also presents a uniquely complex therapeutic challenge. The clinical burden is especially pronounced in patients with diffuse cutaneous systemic sclerosis (dcSSc), where the use of corticosteroids is often limited due to the heightened risk of scleroderma renal crisis. This leaves physicians with a narrow band of anti-fibrotic and immunosuppressive options, many of which are perceived as only modestly effective in controlling ILD progression, let alone reversing it. Even therapies with regulatory approval for SSc-ILD, such as Boehringer Ingelheim's OFEV (nintedanib), garner only measured enthusiasm from treating physicians. While rheumatologists acknowledge nintedanib's potential to slow functional decline, they note it does little to address the underlying autoimmune pathology. Similarly, mycophenolate mofetil and rituximab remain staples of clinical practice, yet their real-world performance is viewed as inconsistent and difficult to monitor. Across the board, satisfaction ratings for currently utilized agents fall short of expectations, reinforcing a treatment landscape still dominated by trial-and-error approaches. This disconnect between disease complexity and treatment efficacy is fueling demand for dual-acting agents, therapies that can address both systemic autoimmunity and pulmonary fibrosis. Nowhere is this demand more visible than in systemic lupus erythematosus-associated ILD (SLE-ILD), where rheumatologists express growing interest in GSK's Benlysta (belimumab). Though not currently approved for ILD, belimumab's immunologic mechanism and expanded label for lupus nephritis have raised hopes that similar benefit may extend to pulmonary manifestations. Across interviews and survey feedback, physicians articulate a desire for treatments that reduce systemic activity while simultaneously preventing fibrotic progression—without the need for an antifibrotic add-on with limited synergy. Looking ahead, specialists are cautiously optimistic about the pipeline. While interest in agents with antifibrotic and immunomodulatory properties is rising, physicians emphasize that what's most needed is not just another drug, but a paradigm shift—a treatment model that reflects the multifaceted nature of CTD-ILD. As one physician summarized, the goal is to 'treat the patient, not just the lungs.' In addition to tracking physician sentiment and practice patterns, the study includes target product profile evaluations for several pipeline therapies: Benlysta (GSK), BMS-986278 (Bristol Myers Squibb), Nerandomilast (Boehringer Ingelheim), and Treprostinil (United Therapeutics). These profiles offer manufacturers timely insights into clinical expectations, adoption potential, and differentiation opportunities in an increasingly complex ILD treatment landscape. Special Topix™ is an independent service that includes access to a report or series of reports based on current events or topics of interest in specialty markets covered by Spherix. About Spherix Global Insights Spherix is a leading independent market intelligence and advisory firm that delivers commercial value to the global life sciences industry, across the brand lifecycle. The seasoned team of Spherix experts provides an unbiased and holistic view of the landscape within rapidly evolving specialty markets, including dermatology, gastroenterology, rheumatology, nephrology, neurology, ophthalmology, and hematology. Spherix clients stay ahead of the curve with the perspective of the extensive Spherix Physician Community. As a trusted advisor and industry thought leader, Spherix's unparalleled market insights and advisory services empower clients to make better decisions and unlock opportunities for growth. To learn more about Spherix Global Insights, visit or connect through LinkedIn. For more details on Spherix's primary market research reports and interactive dashboard offerings, visit or register here: NOTICE: All company, brand or product names in this press release are trademarks of their respective holders. The findings and opinions expressed within are based on Spherix Global Insight's analysis and do not imply a relationship with or endorsement of the companies or brands mentioned in this press release. Disclaimer: The above press release comes to you under an arrangement with GlobeNewswire. Business Upturn takes no editorial responsibility for the same. Ahmedabad Plane Crash
Yahoo
3 days ago
- Yahoo
Pulmonologists and Rheumatologists Struggle to Diagnose and Manage CTD-ILD, According to New Research from Spherix Global Insights
Systemic sclerosis and myositis interstitial lung disease subtypes flagged as most difficult to manage; specialists cite lack of effective treatments and diagnostic clarity EXTON, PA, June 17, 2025 (GLOBE NEWSWIRE) -- According to Spherix Global Insights' newly published Special Topix™: Interstitial Lung Disease in Rheumatology (US) report, both rheumatologists and pulmonologists report significant challenges in diagnosing and managing connective tissue disease-associated interstitial lung disease (CTD-ILD), with systemic sclerosis (SSc) and myositis (IIM) cited as the most difficult subtypes to treat. The research, based on responses from 138 US specialists (n=68 rheumatologists and 70 pulmonologists), highlights persistent unmet needs, diagnostic ambiguity, and a call for more robust and collaborative management strategies. The findings reflect that undiagnosed and misdiagnosed patients make up a substantial portion of the CTD-ILD population, with nearly one-third of rheumatologists and over half of pulmonologists naming differential diagnosis as a key challenge. Specialists underscore a lack of specific biomarkers, logistical biopsy issues, and overlapping symptoms as primary obstacles. 'The most definitive test (biopsy) is invasive. It is difficult to find the clinicians who are willing to do it in a timely manner, and to convince the patient it needs to be done.' – Rheumatologist 'Ensuring the correct diagnosis to avoid misdiagnosing the type of ILD or source of ILD. I usually employ the assistance of a rheumatologist.' – Pulmonologist 'Often it would be difficult to get patients biopsied for logistical reasons, and often the pathology report would not be precise enough.' – Pulmonologist Even once diagnosed, CTD-ILD patients face a treatment landscape with few options to slow or halt disease progression. When asked about the most difficult aspects of management, specialists consistently pointed to a lack of effective and targeted therapies, with SSc-ILD and myositis-ILD receiving the highest unmet need scores. For SSc-ILD specifically, not only is it associated with the most aggressive progression and worst long-term outcomes, but it also presents a uniquely complex therapeutic challenge. The clinical burden is especially pronounced in patients with diffuse cutaneous systemic sclerosis (dcSSc), where the use of corticosteroids is often limited due to the heightened risk of scleroderma renal crisis. This leaves physicians with a narrow band of anti-fibrotic and immunosuppressive options, many of which are perceived as only modestly effective in controlling ILD progression, let alone reversing it. Even therapies with regulatory approval for SSc-ILD, such as Boehringer Ingelheim's OFEV (nintedanib), garner only measured enthusiasm from treating physicians. While rheumatologists acknowledge nintedanib's potential to slow functional decline, they note it does little to address the underlying autoimmune pathology. Similarly, mycophenolate mofetil and rituximab remain staples of clinical practice, yet their real-world performance is viewed as inconsistent and difficult to monitor. Across the board, satisfaction ratings for currently utilized agents fall short of expectations, reinforcing a treatment landscape still dominated by trial-and-error approaches. This disconnect between disease complexity and treatment efficacy is fueling demand for dual-acting agents, therapies that can address both systemic autoimmunity and pulmonary fibrosis. Nowhere is this demand more visible than in systemic lupus erythematosus-associated ILD (SLE-ILD), where rheumatologists express growing interest in GSK's Benlysta (belimumab). Though not currently approved for ILD, belimumab's immunologic mechanism and expanded label for lupus nephritis have raised hopes that similar benefit may extend to pulmonary manifestations. Across interviews and survey feedback, physicians articulate a desire for treatments that reduce systemic activity while simultaneously preventing fibrotic progression—without the need for an antifibrotic add-on with limited synergy. Looking ahead, specialists are cautiously optimistic about the pipeline. While interest in agents with antifibrotic and immunomodulatory properties is rising, physicians emphasize that what's most needed is not just another drug, but a paradigm shift—a treatment model that reflects the multifaceted nature of CTD-ILD. As one physician summarized, the goal is to "treat the patient, not just the lungs." In addition to tracking physician sentiment and practice patterns, the study includes target product profile evaluations for several pipeline therapies: Benlysta (GSK), BMS-986278 (Bristol Myers Squibb), Nerandomilast (Boehringer Ingelheim), and Treprostinil (United Therapeutics). These profiles offer manufacturers timely insights into clinical expectations, adoption potential, and differentiation opportunities in an increasingly complex ILD treatment landscape. Special Topix™ is an independent service that includes access to a report or series of reports based on current events or topics of interest in specialty markets covered by Spherix. About Spherix Global Insights Spherix is a leading independent market intelligence and advisory firm that delivers commercial value to the global life sciences industry, across the brand lifecycle. The seasoned team of Spherix experts provides an unbiased and holistic view of the landscape within rapidly evolving specialty markets, including dermatology, gastroenterology, rheumatology, nephrology, neurology, ophthalmology, and hematology. Spherix clients stay ahead of the curve with the perspective of the extensive Spherix Physician Community. As a trusted advisor and industry thought leader, Spherix's unparalleled market insights and advisory services empower clients to make better decisions and unlock opportunities for growth. To learn more about Spherix Global Insights, visit or connect through LinkedIn. For more details on Spherix's primary market research reports and interactive dashboard offerings, visit or register here: NOTICE: All company, brand or product names in this press release are trademarks of their respective holders. The findings and opinions expressed within are based on Spherix Global Insight's analysis and do not imply a relationship with or endorsement of the companies or brands mentioned in this press release. CONTACT: Andy Stankus, Rheumatology Franchise Head Spherix Global Insights 4848794284 in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
Medscape
3 days ago
- Medscape
CRC Outcomes Better When First of Multiple Cancers
Colorectal cancer (CRC) survival is longer when it's the first of multiple primary malignancies than when it's the second or solo, new data suggest. The findings came from a retrospective analysis of data from the Surveillance, Epidemiology, and End Results (SEER) database of more than half a million people in the US with primary CRC. They were divided into three groups: Group A, with CRC as their only malignancy; group B, with CRC as the first with one or more subsequent primary malignancies; and group C, with CRC as the second of multiple primary malignancies. The finding that Group B had the highest 5-year survival of the three groups is novel and surprised the authors, but they have some theories to explain it. 'We potentially thought group A would do the best, seeing as they only had one type of cancer. But what we found…is that [group B] actually had the best survival outcome. It could have something to do with the tumor characteristics at a molecular biological level, or potentially because of increased surveillance from having colorectal cancer first,' first author Anjelli Wignakumar, MD, told Medscape Medical News . On the other hand, those in group A tended to be younger and to present with more aggressive disease, although they still fared better than did those in group C. 'There are lots of potential explanations,' said Wignakumar, a clinical research fellow in Colorectal Department, Cleveland Clinic, Weston, Florida. Clinically, the takeaway is for comprehensive screening for other types of cancer in people with primary cancers, and in particular screening for CRC in people with other primary cancers. 'Depending on the patient's family history and other things, increasing that screening hopefully increases our risk of picking up something earlier,' she said. Of the total 592,063 patients with CRC in SEER from 2000-2020, 71.8% were in group A, 11.9% in group B, and 16.3% in group C. Group B included a higher proportion of men (57.1% vs 51.8% and 53.1% for A and C, respectively; P < .001). Group A was significantly younger at CRC presentation (65.7 years vs 67.3 years and 72.6 years, for B and C, respectively; P < .001). Those in group A were more likely to have elevated pretreatment tumor marker carcinoembryonic antigen (49.7% vs 43.2% and 46.9%, in B and C, respectively; P < .001) and presented more often with liver metastases (17.5% vs 7.4% and 12.1%, respectively; P < .001) or lung metastases (6.3% vs 2.5% and 4.2%, respectively, P < .001). Right-sided CRC, which has been associated with worse survival compared to left-sided, was more common in group C (38.6%), while left-sided colonic cancer, associated with better survival, was more common in group B (37.9%). Both were significant compared to the other groups ( P < .001). Surgical treatment was recommended significantly ( P < .001) more often for group B (20.5%) than for groups A (13.0%) or C (14.3%), while systemic adjuvant therapy was given significantly ( P < .001) more often to those in group A (29.0%) than groups B (27.8%) or C (21.3%). Compared to group B, overall 5-year mortality hazard ratios were 1.26 for group A, which could be attributed to their more advanced disease, the authors said. Those in group C also had higher 5-year mortality (1.66). Those were both statistically significant, with similar trends for cancer-specific mortality. Mean 5-year survival was 50.4 months for group B, significantly ( P < .001) longer than the 41.8 months for group A and 39.2 months for group C. In their discussion in the paper, Wignakumar and colleagues presented a variety of hypotheses about the findings, including that group B might have a distinct immune profile that 'enhances their ability to survive multiple cancers and potentially improve their responsiveness to treatment.' Alternatively, 'Patients who develop a second primary cancer have already demonstrated resilience, having endured the physical and emotional challenges of their initial cancer treatment. This experience may reflect a stronger baseline health status and the benefits of previous successful interventions, contributing to potentially better survival outcomes compared with those facing cancer for the first time.' Wignakumar had no disclosures.
