Abstract
Idiopathic pulmonary fibrosis (IPF), a fibrosing interstitial lung disease, predominantly affects the elderly and is associated with a high mortality risk. Nintedanib, a tyrosine kinase inhibitor, significantly reduces IPF progression. However, data on the tolerability and efficacy of nintedanib in the elderly with IPF are limited. Therefore, this study aimed to examine the tolerability and efficacy of nintedanib in the elderly with IPF in a real-world setting. Medical records of 19 elderly IPF patients (≥ 75 years) and 46 non-elderly IPF patients (< 75 years) newly administered nintedanib were retrospectively analyzed. We compared the forced vital capacity (FVC) level, incidence and severity of adverse events, and continuation rates of nintedanib between the two groups. FVC and percent predicted diffusing capacity of the lung for carbon monoxide (DLco) were lower in the elderly IPF group at baseline. Although the elderly IPF patients had a significantly higher incidence of adverse events, such as diarrhea, nausea, and elevation of hepatic enzymes, the rate of discontinuation of nintedanib owing to adverse events was not different between the groups. The continuation rates of nintedanib treatment at 6 months and 1 year in the elderly IPF group were equivalent. Furthermore, there was a similar trend in the reduction of the annual FVC decline after nintedanib initiation between the groups. Our study demonstrated that nintedanib was tolerable in both the IPF patient groups in a real-world setting. Proper management of adverse events in the elderly with IPF would lead to a better clinical outcome.
Highlights
Idiopathic pulmonary fibrosis (IPF) is the most common form of idiopathic interstitial pneumonias [1, 2]
Five patients were diagnosed with IPF using surgical lung biopsy samples, and the other patients were diagnosed with clinical IPF after multidisciplinary discussion (MDD)
There was a significant difference between the two groups in terms of long-term oxygen therapy (LTOT); 14 (73.7%) elderly IPF patients and 17 (37.0%) non-elderly IPF patients were treated with LTOT (p = 0.007) at baseline
Summary
Idiopathic pulmonary fibrosis (IPF) is the most common form of idiopathic interstitial pneumonias [1, 2]. IPF is a chronic and progressive fibrosing interstitial lung disease (ILD) of unknown etiology [1, 3]. Tolerability of nintedanib in the elderly with idiopathic pulmonary fibrosis prognosis of IPF is difficult to predict [1, 7, 8]. Mortality in the case of IPF has been associated with the occurrence of dyspnea, poor pulmonary function, poor exercise capacity, and extent of lung fibrosis on high-resolution computed tomography (HRCT) [1]. A multidimensional index and staging system using clinical (e.g., gender and age) and physiological (e.g., forced vital capacity [FVC] and diffusing capacity of the lung for carbon monoxide [DLco]) variables, GAP, has been reported [9]
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