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. Author manuscript; available in PMC: 2026 Oct 1.
Published in final edited form as: Am J Respir Crit Care Med. 2026 Apr 1;212(4):768–777. doi: 10.1093/ajrccm/aamag006

Figure 4.

Figure 4

Forest Plot showing the association between immunosuppressant (IS) exposure (mycophenolate or azathioprine) and risk of death or lung transplantation within 3 years, stratified by molecular endotype (class 1 = blue; class 2 = red) and ILD subtype (CTD-ILD = top; IIP and fHP = bottom) in the pooled discovery and validation cohorts. IS exposure was modeled as a time-varying covariate to mitigate immortal time bias. Inverse probability of treatment weighting was applied to adjust for indication bias, accounting for covariates known or suspected to influence treatment probability or survival: age, sex (female, male), race (White, non-White), smoking history (ever, never), ILD subtype (CTD-ILD, fHP, IIP), treating center, baseline lung function, and prednisone use at blood draw (yes, no). Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards models with robust variance estimation. P-values were derived from the Wald test. Abbreviations: CTD-ILD, connective tissue disease-associated interstitial lung disease; fHP, fibrotic hypersensitivity pneumonitis; HR, hazard ratio; IIP, idiopathic interstitial pneumonia; ILD, interstitial lung disease; IS, immunosuppressant; P-int. = P-value for the interaction term.