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Review
. 2017 Jun 28;4(1):e000192.
doi: 10.1136/bmjresp-2017-000192. eCollection 2017.

Clinical use of nintedanib in patients with idiopathic pulmonary fibrosis

Amy Hajari Case  1 , Peace Johnson  1
Affiliations
Review

Clinical use of nintedanib in patients with idiopathic pulmonary fibrosis

Amy Hajari Case et al. BMJ Open Respir Res. .

Abstract

Idiopathic pulmonary fibrosis (IPF) is a rare lung disease characterised by progressive loss of lung function, dyspnoea and cough. IPF has a variable clinical course but a poor prognosis. Nintedanib, a tyrosine kinase inhibitor, is one of two drugs approved for the treatment of IPF. In clinical trials, nintedanib slowed disease progression by reducing the rate of decline in forced vital capacity (FVC) in patients with IPF and mild or moderate lung function impairment. The effect of nintedanib was consistent across patient subgroups defined by baseline characteristics including FVC % predicted, diffusion capacity of the lung for carbon monoxide % predicted and the presence of emphysema. Recently, it has been shown that the rate of decline in FVC and the treatment effect of nintedanib are the same in patients with preserved lung volume (FVC >90% predicted) as in patients with greater impairment in FVC, supporting the value of early treatment of IPF. The adverse events most commonly associated with nintedanib, both in clinical trials and real-world clinical practice, are mild gastrointestinal events, particularly diarrhoea. Side effects are manageable in a majority of patients through symptomatic treatment, dose reductions and treatment interruptions, enabling most patients to stay on treatment in the long term.

Keywords: Interstitial Fibrosis; Rare lung diseases.

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Conflict of interest statement

Competing interests: Amy Case reports personal fees from Boehringer Ingelheim outside the submitted work. Peace Johnson reports no competing interests.

Figures

Figure 1
Figure 1
FVC decline across subgroups of patients in the INPULSIS trials by baseline characteristics (reproduced with permission from ref. 21).
Figure 2
Figure 2
Algorithm for management of diarrhoea in the INPULSIS trials (reproduced with permission from ref.  18).
See this image and copyright information in PMC

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