C39-33 Sex-specific Phenotypes and Outcomes in Non-IPF Interstitial Lung Disease: Results From the INSIGHTS-ILD Registry

Sex-specific aspects of non-IPF interstitial lung diseases (ILD) are incompletely characterized. In the prospective INSIGHTS-ILD registry (data cut 17 Sep 2025), we compared men and women with non-IPF ILD using descriptive analyses and Cox models (Model A: age, comorbidity count, smoking; Model B: additionally, Forced Vital Capacity (FVC) and diffusion capacity for carbon monoxide (DLCO)) Among 883 patients (483 men; 400 women), age and body mass index were similar. Women were more often never-smokers, whereas men more frequently reported occupational/ environmental exposures; family history of ILD was more common in women. Fibrotic idiopathic interstitial pneumonia -was more prevalent in men, systemic sclerosis-associated ILD in women. Men had a higher comorbidity burden (notably coronary artery disease) and were more often on antifibrotics at baseline. Kaplan-Meier curves showed longer survival in women (unadjusted Hazard Ratio for men 1.51, 95% CI 1.03-2.21); the association was not significant in Model A (HR 1.04, 0.65-1.68) and borderline significant in Model B (HR 1.84, 0.99-3.40; p = 0.052). Progression-free survival (PFS) did not differ consistently by sex, but male sex was significant in Model B (HR 1.44, 1.05-1.98). Longitudinal physiology showed modest declines in FVC and DLCO in both sexes with largely parallel trajectories and no significant between-sex differences. Overall, sex was associated with differences in exposures, entities, comorbidities, and treatment; after minimal adjustment sex itself was not a robust predictor of survival, while extended models suggested a borderline higher risk for men. This abstract is funded by: Boehringer Ingelheim AG & Co. KG