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Internal Medicine • Rheumatology • Interstitial lung disease • General Rheumatology • Pulmonology • RheumMadness
Do you generally recommend starting nintedanib prior to immunosuppressive therapy in a patient with CTD-ILD?
Do you prefer to start with nintedanib and then add immunosuppressive agents, or give a trial of immunosuppressive medication first, then add nintedanib later?
This question is part of a collaboration with RheumMadness and is specifically in reference to: INBUILD
Answer from: at Academic Institution
Patients with autoimmune disease-associated ILDs such as those with rheumatoid arthritis-related ILD, Sjogren and inflammatory myositis-related ILD are usually on background DMARD/immunosuppressive therapy already at the time the ILD is detected. These therapies are also important in helping to redu...
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Answer from: at Academic Institution
The CTD-ILD patients who were part of the INBUILD study were not on any DMARDs during the trial. There was no sub-group analysis but in the overall population, the adjusted rate of decline in the FVC over the 52-week period was more favorable in the nintedanib group regardless of underlying diagnosi...
Answer from: at Community Practice
Not typically, for a few reasons. We all have patients where their joints are totally fine and their lungs are leading the way, but the average CTD-ILD patient's ILD is synchronous with their extra-pulmonary disease. As a result, we see more overall benefits in treating these patients with immune su...
Answer from: at Academic Institution
Generally not as in CTD-ILD, it is the underlying CTD that is driving ILD and this must be controlled. Furthermore, patients with CTD often have extrapulmonary manifestations of their disease that need to be addressed in order to decrease morbidity and mortality. However, I am quick to prescribe nin...