Interstitial pulmonary fibrosis: Nintedanib slows progression of all forms of pulmonary fibrosis

Interstitial pulmonary fibrosis is a group of diseases characterized by gradual fibrosis of lung tissue and is common in a variety of interstitial lung diseases. Their common feature is the gradual decline of lung function, which seriously affects the patient's quality of life. In high-resolution computed tomography (HRCT), the patient's lungs will show a significant increase in opacity, reflecting the degeneration and fibrosis process of the lung tissue. Due to the complex mechanisms of interstitial pulmonary fibrosis, current treatment options are relatively limited, especially in the treatment of other forms of pulmonary fibrosis other than idiopathic pulmonary fibrosis (IPF).

Nintedanib (Nintedanib) is a new type of tyrosine kinase inhibitor, mainly used to treat idiopathic pulmonary fibrosis. However, a growing body of research suggests that nintedanib may also be effective in slowing the progression of other forms of pulmonary fibrosis. Its mechanism of action is to prevent the proliferation and migration of fibroblasts by inhibiting fibroblast growth factor (FGF) and other related signaling pathways, thereby effectively reducing the rate of pulmonary fibrosis.

To further explore the effectiveness of nintedanib in all forms of pulmonary fibrosis, a prospective randomized, double-blind and placebo-controlled trialINBUILD was established. The study enrolled 633 patients at 153 centers in 15 countries, including Germany. These patients had progressed interstitial lung disease over the past 24 months despite treatment, and their vital capacity (FVC) was only 45% of expected value, while the carbon monoxide (CO) diffusing capacity of the lungs decreased to between 30% and 80% of expected value, indicating that their lung function was severely affected.

In the study design, participants were randomly assigned to receive nintedanib (150 mg twice daily) or placebo for 52 weeks. The primary endpoint was change in FVC, which is widely used to assess lung function. During the study, the research team conducted detailed observations on patients with typical interstitial pneumonia (UIP) on CT images. These imaging features include patchy fibrosis and honeycomb lung structure.

Trial results showed that patients treated with nintedanib had a significant FVC loss of 80.8 ml per year compared with 187.8 ml in the placebo group (Δ107.0 mL, 95% confidence interval [95%CI] [65.4; 148.5]; p<0.001). Particularly among patients with UIP samples, FVC loss was limited to 82.9 mL/year in the nintedanib group compared with 211.1 mL/year in the placebo group (Δ128.2 mL/year; [70.8; 185.6]; p<0.001). These data demonstrate that nintedanib has significant benefits in slowing the progression of pulmonary fibrosis and helping patients maintain better lung function.

However, the use of nintedanib is also associated with some adverse reactions, the most common of which is diarrhea. The incidence rate in the nintedanib group was 66.9%, while that in the placebo group was 23.9%. In addition, the incidence of liver function abnormalities was more common in the nintedanib group. Therefore, during the use of nintedanib, doctors need to closely monitor patients to detect and deal with possible adverse reactions in a timely manner.

In conclusion, nintedanib, as a tyrosine kinase inhibitor, not only plays an important role in the treatment of idiopathic pulmonary fibrosis, but also shows potential in slowing the progression of pulmonary fibrosis associated with other interstitial lung diseases. Supported by effective clinical research data, nintedanib has become an important treatment option, helping patients improve their quality of life and delay disease progression.

References:https://www.aerzteblatt.de/fachgebiete/pneumologie/interstitielle-lungenfibrose-nintedanib-verlangsamt-progression-bei-allen-formen-der-lungenfibrose-e9d4624d-87f4-4e89-94d0-2142adafa3c4