Effects of nintedanib on liver damage

Nintedanib (Nintedanib) is a targeted therapy drug mainly used for idiopathic pulmonary fibrosis (IPF), chronic fibrosing interstitial lung disease (ILD) and systemic sclerosis-related interstitial lung disease (SSc-ILD). Although nintedanib has shown good efficacy in the treatment of these diseases, its potential damage to the liver cannot be ignored.

The effect of nintedanib on liver function is an important concern. Clinical studies and later observation reports show that cases of liver function damage are gradually increasing. According to the drug instructions, the use of nintedanib is not recommended for patients with moderate (Child Pugh B) or severe (Child Pugh C) hepatic impairment; while for patients with mild hepatic impairment (Child Pugh A), it can be used with an appropriate dose reduction. This policy not only considers patient safety, but also reflects the problems that nintedanib may cause in liver metabolism.

Elevated liver enzymes are often associated with drug-induced liver injury (DILI). In multiple clinical trials, the use of nintedanib has been significantly associated with increases in liver enzymes (such as ALT and AST) and bilirubin levels. Most events of elevated liver enzymes occurred in the first three months of treatment, suggesting that medical staff need to pay special attention to changes in patients' liver function in the early stages of treatment. Although elevated liver enzymes generally return to normal after dose adjustment or discontinuation of medication, individual severe cases may lead to fatal consequences, so a high degree of vigilance must be maintained.

In clinical practice, medical staff should regularly monitor patients' liver function, includingALT, AST, and bilirubin levels, before starting treatment and during the first three months of treatment. If the patient develops symptoms such as fatigue, loss of appetite, discomfort in the right upper abdomen, darkened urine, or jaundice during treatment that may indicate liver damage, liver function tests should be performed immediately so that timely intervention can be taken.

Reference materials:https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=da1c9f37-779e-4682-816f-93d0faa4cfc9##