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Internal Medicine • Rheumatology • Interstitial lung disease • Pulmonology • ACR Journal Club
What is your approach to using nintedanib in patients on baseline immunosuppression?
Patients on baseline mycophenolate and azathioprine were excluded from the INBUILD trial however many patients with CTD-ILD will be on some form of immunosuppression.
Answer from: at Community Practice
Typically I start antifibrotic therapy in a few situations:
The most common reason is ILD progression despite adequate immune suppression, defined as no extra-pulmonary disease activity (usually joint disease, but can tailor according to the patient's disease/situation, such as by presence of rash,...
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Answer from: at Academic Institution
Generally, I like to prescribe nintedanib after someone has been stabilized on their immunosuppressive therapy in order to help mitigate potential adverse events that could be wrongly assigned to nintedanib. This is the strategy that was taken in the pivotal trials.
Answer from: at Community Practice
Remembering that mycophenolate is also an anti-fibrotic, meaning that it interferes with the fibrotic pathway and the evolution of fibrosis. If we look at the SLS trials which demonstrated significant improvement with CYC and MMF each in pulmonary function, HRQoL and symptoms scales, skin score (wit...
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at Vanderbilt University School of Medicine
This is a very common sense approach and step-up e...
This is a very common sense approach and step-up e...
Answer from: at Academic Institution
My approach is to add the nintedanib to the baseline immunosuppression, and not to stop immunosuppression.
Answer from: at Academic Institution
If you look at Figure 4B in this Delphi consensus paper on treating patients with SSc-ILD, the consensus of expert pulmonologists/rheumatologists is to "add on" additional therapies to MMF if there is lack of response, unable to tolerate MMF, etc. Rahaghi et al., PMID 36624431.