Few studies analyzed gender-related outcomes and characteristics differences of patients with idiopathic pulmonary fibrosis (IPF). The aim of the study was to explore gender differences in a French IPF cohort.

236 patients with incident IPF were included in the multicentric longitudinal prospective cohort COhorte FIbrose (COFI), and followed for 5 years. Men and women were compared for characteristics atinclusion (t-test, Chi² or ANOVA) and survival (Log rank, Cox model).

The population consisted of 51 (22%) women and 185(78%) men. At inclusion women significantly differed from men for an older age (>65 years, 78 vs. 61%, P=0.028), a lower proportion of smokers (P<0.001) and lower frequency of occupational exposure (P=0.012). At baseline forced vital capacity (FVC) was significantly better in women (83±25 vs. 75±19%, P=0.046); honeycombing (78.4 vs. 90.3%, P=0.041) and emphysema (11.8 vs. 25.9%, P=0.029) on CT scan were less common in women. Comorbidities such as osteoporosis (9.8 vs. 2.2%, P=0.025) and thromboembolic events (11.8 vs. 2.2%, P=0.008) were more frequently reported among women. Women were less likely to be transplanted (2 vs. 11%, P=0.039). Survival median was comparable between men and women (31months vs. 40 months, P=0.2). After adjusting for age and FVC at inclusion, being a woman was not associated to a better survival.

At diagnosis women appear to have a distinct imaging pattern and a better FVC, which may be due to less exposure history compared to men. However, outcomes remain comparable in both sexes. Less access to lung transplantation in women may be due to age and comorbidities.