Antifibrotic therapy effective in patients with negative lung function prognostics

A post-hoc trial analysis revealed nintedanib treatment benefit in patients with 4 characteristics associated with a fast decline in lung function.

"Once these patients are on nintedanib, there is a stabilisation"

“The SENSCIS trial reflected a real-world population and allowed broad inclusion criteria,” Prof. Christopher  Denton (University College London, UK) explained1,2. “Our analysis aimed to assess the effect of nintedanib on the rate of forced vital capacity (FVC) decline but focusing on subjects with risk factors for rapid FVC decline,” he said. Post-hoc, the rate of decline in FVC (mL/year) over 52 weeks was analysed in subjects with the following 4 risk factors at baseline: early SSc (<18 months since the onset of first non-Raynaud symptom); elevated inflammatory markers (CRP ≥6 mg/L and/or platelets ≥330 x 109/L); and significant skin fibrosis using 2 approaches: modified Rodnan skin score (mRSS) 15–40 or mRSS ≥ 6.

Compared with the total population of the SENSCIS trial, participants with 1 of the 4 characteristics had a numerically greater decline in lung function. “Conversely, once these patients are on nintedanib, there is a stabilisation,” Prof. Denton said. These results support the prompt initiation of nintedanib in patients with SSc-ILD to preserve lung function and improve patient outcomes.

“I think this is an important analysis in terms of our clinical practice and perhaps future trial designs. It does support using nintedanib in this group of patients that might be at particular risk for lung function decline,” Prof. Denton concluded.

1. Denton CP, et al. Effect of nintedanib in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD) and risk factors for rapid decline in forced vital capacity: further analyses of the SENSCIS trial.  OP0157, EULAR 2022, 1-4 June, Copenhagen, Denmark.
2. Distler O, et al. N Engl J Med 2019; 380:2518–2528.