Nintedanib—Efficacy, Safety and Practical Aspects of Treatment for Patients with Idiopathic Pulmonary Fibrosis

Abstract

Idiopathic pulmonary fibrosis (IPF) is a rare disease with progressive course and a very unfavourable prognosis. Antifibrotic drugs are a chance to reduce the rate of disease progression and extend the life of IPF patients. One of these drugs is nintedanib, an oral tyrosine kinase inhibitor. In the following article, the reader will find a summary of current knowledge on the efficacy and safety of nintedanib treatment of IPF patients. This study uses data from pivotal studies and experience from everyday clinical practice indicating a wide range of possible applications of the drug in IPF patients.

Therapeutic decisions in a cohort of patients with idiopathic pulmonary fibrosis: a multicenter, prospective survey from Poland

“…Although both pirfenidone and nintedanib may produce a number of drug interactions mainly driven by disruption of the cytochrome P450 metabolic pathway in the liver, 24 the most widely discussed aspect of antifibrotic treatment in the context of concomitant medication is the simultaneous use of nintedanib and anticoagulative and antiplatelet agents. 10 , 25 Due to inhibition of PDGF and VEGF, both of which are important regulators of angiogenesis, 25 nintedanib may be associated with increased risk of bleeding. Hence, patients receiving anticoagulative treatment were not included in registration studies.…”

“…Nintedanib, an oral tyrosine kinase inhibitor with a multipoint mechanism of action, including an inhibitory effect on vascular endothelial growth factor receptors (VEGFR 1–3), platelet-derived growth factor receptors (PDGFR a and b), and fibroblast growth factor receptors (FGFR 1–3), slows the rate of IPF progression and reduces the risk of acute exacerbations of the disease. 9 , 10 These two antifibrotics are recognized as an actual standard of pharmacological treatment of IPF, 11 and there are emerging data that they are also effective in other fibrosing interstitial lung diseases (ILDs). 12 – 14 Both pirfenidone and nintedanib are available in Poland and are currently fully reimbursed for patients with IPF in the frame of the IPF therapeutic program of the Polish National Health Fund (NHF).…”

Progressive Fibrosis in Interstitial Lung Diseases—Proposed Definition and Management

“…In randomised placebo-controlled clinical trials, nintedanib (TOMMOROW, INPULSIS-1, INPULSIS-2) and pirfenidone (CAPACITY-004, CAPACITY-006, ASCEND) were found to effectively and significantly reduce the decline in www.journals.viamedica.pl FVC, which translates into slowing down the IPF progression [21][22][23][24]. Both medicines have been approved for the treatment of IPF, and the positive effects obtained in clinical practice, along with the trends towards prolonged survival in the treated patients with an acceptable treatment tolerability, prompted further studies in indications extended to other interstitial diseases associated with fibrosis [25][26][27][28][29].…”

Discovery of an Oxycyclohexyl Acid Lysophosphatidic Acid Receptor 1 (LPA1) Antagonist BMS-986278 for the Treatment of Pulmonary Fibrotic Diseases

“…The currently approved therapies for IPF, pirfenidone and nintedanib, slow the decline of forced vital capacity (FVC; a direct measure of lung function) in patients with IPF, but are associated with significant tolerability considerations (particularly GI tolerability). Thus, novel IPF treatments with good safety and tolerability are still needed to further slow or halt FVC decline in patients with IPF.…”