Would you initiate antifibrotic therapy in a patient with CTD-ILD experiencing worsening symptoms and declining lung function, despite no clear evidence of fibrosis on CT scans?  

If the predominant findings on CT were ground glass opacities and/or nodules without any evidence of fibrosis on CT, I would not start with an antifibrotic and, instead, would start with immunosuppression as a first-line agent. Based on the American College of Rheumatology (ACR) and American Thoraci...

In the INBUILD study apart from having 10% fibrosis on CT, they also needed to have at least one of the following criteria for the progression of ILD within the 24 months before screening:  1. Despite standard treatment with an agent other than nintedanib or pirfenidone: a relative decline in ...

Evidence of pulmonary fibrosis was required in the clinical trials of pulmonary antifibrotics. An RTC exploring the effects of an antifibrotic on individuals who have CTD-ILD without fibrosis and with worsening lung function would need to be done to give an informed answer to this question.