Viswanathan Vinod K, Ghoshal Aloke G, Mohan Anant, Patil Ketaki, Bhargave Chaitanya, Choudhari Sanjay, Mehta Suyog
Institute of Thoracic Medicine, Madras Medical College, Chennai, India.
National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India.
Pulm Ther. 2024 Dec;10(4):377-409. doi: 10.1007/s41030-024-00271-1. Epub 2024 Sep 28.
A severe and progressive interstitial lung disease (ILD) known as idiopathic pulmonary fibrosis (IPF) has an unknown etiology with poorly defined mechanisms of development. Among the currently prescribed pharmacological interventions for IPF, nintedanib demonstrates the ability to decelerate the deterioration of lung function and yield positive clinical outcomes. Multiple randomized placebo-controlled trials have confirmed the efficacy and acceptable safety profile of nintedanib. Real-world evidence studies also support the use of nintedanib in IPF, being an efficient and well-tolerated treatment option. It has the potential to stabilize the disease progression in patients with ILD. Patients with IPF frequently have comorbidities like diabetes and hypertension, which can exacerbate the course of disease, reduce quality of life, and decrease treatment adherence. For well-informed decision-making, it is important for healthcare professionals to recognize the position of nintedanib therapy in IPF with comorbidities. The gastrointestinal adverse effects, notably diarrhea, dominate the nintedanib safety profile. These can be effectively controlled by closely monitoring side effects, administering anti-diarrheal and anti-emetic drugs, reducing the nintedanib dose, and discontinuing it in case of severe symptoms with an option to reintroduce the treatment after side effects subside. Symptomatic interventions and monitoring of liver enzymes may reduce the occurrence of permanent treatment discontinuations.
一种名为特发性肺纤维化(IPF)的严重进行性间质性肺疾病(ILD)病因不明,发病机制也不明确。在目前用于治疗IPF的药物干预措施中,尼达尼布显示出减缓肺功能恶化并产生积极临床结果的能力。多项随机安慰剂对照试验已证实尼达尼布的疗效和可接受的安全性。真实世界证据研究也支持在IPF中使用尼达尼布,它是一种有效且耐受性良好的治疗选择。它有可能稳定ILD患者的疾病进展。IPF患者常伴有糖尿病和高血压等合并症,这些合并症会加剧疾病进程、降低生活质量并减少治疗依从性。为了做出明智的决策,医疗保健专业人员认识到尼达尼布治疗在合并有其他疾病的IPF中的地位很重要。胃肠道不良反应,尤其是腹泻,在尼达尼布的安全性方面占主导地位。通过密切监测副作用、给予止泻药和止吐药、降低尼达尼布剂量以及在出现严重症状时停药,并在副作用消退后选择重新引入治疗,可以有效控制这些不良反应。对症干预和监测肝酶可能会减少永久性停药的发生。