Application of nintedanib in the treatment of interstitial lung disease: analysis of efficacy and safety

Interstitial Lung Disease (ILD) is a group of lung diseases characterized by interstitial structural damage, with diverse clinical manifestations and rapid progression. In recent years, nintedanib, as a tyrosine kinase inhibitor, has received widespread attention, especially in the treatment of idiopathic pulmonary fibrosis (IPF) and other related types of interstitial lung diseases. This article will comprehensively discuss the efficacy and adverse reactions of nintedanib in the treatment of interstitial lung disease, and provide reference for clinical application.

Nintedanib mainly targets a variety of intracellular tyrosine kinases and inhibits the progression of pulmonary fibrosis by intervening in signaling pathways. Studies have shown that nintedanib can effectively slow down the progression of idiopathic pulmonary fibrosis and systemic sclerosis-related interstitial lung disease, and is also effective in progressive chronic fibrosing interstitial lung disease. This discovery prompted regulatory approval, making it an important treatment option for patients with interstitial lung disease.

To evaluate the clinical effect of nintedanib, many randomized controlled trials were designed and conducted. Through a literature review of databases such as PubMed, EMBASE, Cochrane CENTRAL and Cochrane CDSR, a total of 6 studies were included, involving 2583 patients who received treatment. The results showed that nintedanib can significantly reduce the progression rate of interstitial lung disease, which is specifically reflected in the slowdown in the decline of forced vital capacity (FVC). In addition, these studies also provide us with data on potential adverse events.

While nintedanib is excellent at improving lung function, its rate of adverse events has raised widespread concern. The data showed that patients receiving nintedanib had an approximately 139% increased risk of experiencing any type of adverse event (odds ratio OR = 2.39). In particular, the risk of treatment discontinuation due to adverse events increased to 74% (OR = 1.74). However, some studies have pointed out that there may be a certain negative correlation trend between nintedanib and the incidence of fatal adverse events (OR = 0.70), which suggests that we need to conduct a comprehensive risk assessment.

Among the specific adverse events, the occurrence of diarrhea was particularly significant, with an odds ratio of 5.97, showing a high correlation. In addition, the incidence rates of side effects such as nausea, vomiting and weight loss were also higher than those in the placebo group, with corresponding odds ratios of 3.00, 3.23 and 3.39 respectively. It is worth noting that although nintedanib may cause digestive system discomfort, it helps reduce the occurrence of cough and dyspnea, with associated odds ratios of 0.74 and 0.71, suggesting that it has a protective effect in some aspects.

In summary, nintedanib shows certain effectiveness in the treatment of interstitial lung disease, but it is accompanied by a higher risk of adverse events. Therefore, during clinical application, doctors need to fully communicate with patients to weigh the benefits and risks. For patients using nintedanib, it is recommended to closely monitor their adverse reactions during treatment, especially symptoms related to the digestive system, so that the treatment plan can be adjusted in a timely manner to ensure patient safety and therapeutic effect.

Reference materials:https://pubmed.ncbi.nlm.nih.gov/33989328/