Real-world experience of nintedanib for progressive fibrosing interstitial lung disease in the UK
Authors: Dixon Giles , Hague Samuel , Mulholland Sarah , Adamali Huzaifa , Khin Aye Myat Noe , Thould Hannah , Connon Roisin , Minnis Paul , Murtagh Eoin , Khan Fasihul , Toor Sameen , Lawrence Alexandra , Naqvi Marium , West Alex , Coker Robina K. , Ward Katie , Yazbeck Leda , Hart Simon , Garfoot Theresa , Newman Kate , Rivera-Ortega Pilar , Stranks Lachlan , Beirne Paul , Bradley Jessica , Rowan Catherine , Agnew Sarah , Ahmad Mahin , Spencer Lisa G. , Aigbirior Joshua , Fahim Ahmed , Wilson Andrew M. , Butcher Elizabeth , Chong Sy Giin , Saini Gauri , Zulfikar Sabrina , Chua Felix , George Peter M. , Kokosi Maria , Kouranos Vasileios , Molyneaux Philip , Renzoni Elisabetta , Vitri Benedetta , Wells Athol U. , Nicol Lisa M. , Bianchi Stephen , Kular Raman , Liu HuaJian , John Alexander , Barth Sarah , Wickremasinghe Melissa , Forrest Ian A. , Grimes Ian , Simpson A. John , Fletcher Sophie V. , Jones Mark G. , Kinsella Emma , Naftel Jennifer , Wood Nicola , Chalmers Jodie , Crawshaw Anjali , Crowley Louise E. , Dosanjh Davinder , Huntley Christopher C. , Walters Gareth I. , Gatheral Timothy , Plum Catherine , Bikmalla Shiva , Muthusami Raja , Stone Helen , Rodrigues Jonathan C.L. , Tsaneva-Atanasova Krasimira , Scotton Chris J. , Gibbons Michael A. , Barratt Shaney L. 
Published: January 2024

Background

Nintedanib slows progression of lung function decline in patients with progressive fibrosing (PF) interstitial lung disease (ILD) and was recommended for this indication within the United Kingdom (UK) National Health Service in Scotland in June 2021 and in England, Wales and Northern Ireland in November 2021. To date, there has been no national evaluation of the use of nintedanib for PF-ILD in a real-world setting.

Methods

26 UK centres were invited to take part in a national service evaluation between 17 November 2021 and 30 September 2022. Summary data regarding underlying diagnosis, pulmonary function tests, diagnostic criteria, radiological appearance, concurrent immunosuppressive therapy and drug tolerability were collectedviaelectronic survey.

Results

24 UK prescribing centres responded to the service evaluation invitation. Between 17 November 2021 and 30 September 2022, 1120 patients received a multidisciplinary team recommendation to commence nintedanib for PF-ILD. The most common underlying diagnoses were hypersensitivity pneumonitis (298 out of 1120, 26.6%), connective tissue disease associated ILD (197 out of 1120, 17.6%), rheumatoid arthritis associated ILD (180 out of 1120, 16.0%), idiopathic nonspecific interstitial pneumonia (125 out of 1120, 11.1%) and unclassifiable ILD (100 out of 1120, 8.9%). Of these, 54.4% (609 out of 1120) were receiving concomitant corticosteroids, 355 (31.7%) out of 1120 were receiving concomitant mycophenolate mofetil and 340 (30.3%) out of 1120 were receiving another immunosuppressive/modulatory therapy. Radiological progression of ILD combined with worsening respiratory symptoms was the most common reason for the diagnosis of PF-ILD.

Conclusion

We have demonstrated the use of nintedanib for the treatment of PF-ILD across a broad range of underlying conditions. Nintedanib is frequently co-prescribed alongside immunosuppressive and immunomodulatory therapy. The use of nintedanib for the treatment of PF-ILD has demonstrated acceptable tolerability in a real-world setting.