Hint of benefit with antifibrotic treatment seen for interstitial lung disease

Antifibrotic treatment appears to put brakes on the decline of lung function, as evidenced by forced vital capacity (FVC) measurements, in patients with interstitial lung disease (ILD) related to connective tissue disease (CTD) or rheumatoid arthritis (RA), according to a study.

Researchers conducted a systematic review and meta-analysis of studies in which the efficacy and safety of antifibrotic agents in the treatment of CTD-ILD and RA-ILD were investigated. Multiple online databases were searched for relevant studies, and 10 studies with a total of 880 participants met the inclusion criteria.

Of the 10 studies, four were included in the meta-analysis, with a total of 880 participants. Of these participants, 440 were in the antifibrotic agent group and 440 in the placebo group. ILD was related to systemic sclerosis (SSc) in 649 patients, related to RA in 212, and related to mixed CTD in 19. Pirfenidone was given as the treatment intervention in two studies, and nintedanib was used in other studies.

Pooled data showed that compared with placebo, antifibrotic drug use led to a significant decrease in the annual decline of FVC (mean difference [MD], 70.58 mL per year, 95 percent confidence interval [CI], 40.55–100.61). Specifically, the annual decline of FVC slowed by 80.00 mL per year with pirfenidone and by 61.35 mL per year with nintedanib.

In a subgroup analysis, nintedanib resulted in a significant reduction in the annual decline of FVC for patients with SSc-ILD (MD, 44.51 mL per year) but not CTD-ILD (MD, 35.40 mL per year). Meanwhile, patients with RA-ILD had a significant reduction in the annual decline of FVC with both pirfenidone (MD, 80.00 mL per year) and nintedanib (MD, 118.20 mL per year).

The present data highlight the potential benefit and safety of antifibrotic treatment in slowing the decline of FVC in patients with CTD-ILD and RA-ILD. More studies are needed to provide more evidence that can aid decision-making regarding the use of antifibrotics in this population.