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DOI: 10.1055/a-1825-4967
Einsatz antifibrotischer Medikamente bei interstitiellen Lungenerkrankungen
Use of antifibrotic drugs in interstitial lung disease
Interstitielle Lungenerkrankungen (ILD) führen oftmals zu einer progredienten Fibrosierung der Lunge und damit zu entsprechenden Funktionseinschränkungen. Bei der rasch fortschreitenden idiopathischen pulmonalen Fibrose (IPF) sind antifibrotische Medikamente bereits seit einigen Jahren in der Therapie etabliert. Der Beitrag bietet eine Übersicht über den Einsatz antifibrotischer Medikamente, sowohl bei der IPF als auch bei den speziellen non-IPF-ILDs.
Abstract
The interstitial lung diseases ILDs are a heterogeneous group of diseases that often lead to progressive fibrosis of the lungs with corresponding functional impairment. With nintedanib, a tyrosinkinase inhibitor and angiokinase inhibitor, as well as pirfenidone, which unfolds its effect among other things by inhibiting the transforming growth factor β, there are currently 2 approved antifibrotic drugs. In the rapidly progressing idiopathic pulmonary fibrosis IPF, the antifibrotic drugs nintedanib and pirfenidone have been established and approved in therapy for several years. The initiation of antifibrotic therapy should be carried out early after diagnosis by multidisciplinary discussion (MDD). In systemic scleroderma with lung involvement nintedanib should be used in the case of relevant fibrosis in addition to immunosuppressive therapy. Recently, nintedanib has also become a new option for the treatment of progressive fibrosing ILDs (PF-ILDs). This describes the course of various disease entities such as connective tissue disease associated ILDs (CTD-ILDs), fibrosing hypersensitivity pneumonitis or fibrosing courses of non-IPF idiopathic interstitial pneumonitis (non-IPF IIPs) that have a corresponding fibrose-related worsening of respiratory symptoms, a deterioration of lung-functioning parameters or a disease progression in CT. Although pirfenidone also shows positive signals for this group of patients in some selected studies, its use in PF-ILD is not yet recommended. In particular, gastrointestinal side effects can occur under therapy with antifibrotic drugs and require a long-term close interdisciplinary connection of patients.
Schlüsselwörter
interstitielle Lungenerkrankungen - antifibrotische Therapie - Nintedanib, PirfenidonPublication History
Article published online:
24 October 2022
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Literatur
- 1 Wollin L, Wex E, Pautsch A. et al. Mode of action of nintedanib in the treatment of idiopathic pulmonary fibrosis. Eur Respir J 2015; 45: 1434-1445
- 2 Kwapiszewska G, Gungl A, Wilhelm J. et al. Transcriptome profiling reveals the complexity of pirfenidone effects in idiopathic pulmonary fibrosis. Eur Respir J 2018; 52
- 3 Raghu G, Anstrom KJ, King TE. et al. Prednisone, azathioprine, and N-acetylcysteine for pulmonary fibrosis. N Engl J Med 2012; 366: 1968-1977
- 4 Oldham JM, Witt LJ, Adegunsoye A. et al. N-acetylcysteine exposure is associated with improved survival in anti-nuclear antibody seropositive patients with usual interstitial pneumonia. BMC Pulm Med 2018; 18: 30
- 5 Noble PW, Albera C, Bradford WZ. et al. Pirfenidone in patients with idiopathic pulmonary fibrosis (CAPACITY): two randomised trials. Lancet 2011; 377: 1760-1769
- 6 King TE, Bradford WZ, Castro-Bernardini S. et al. A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis. N Engl J Med 2014; 370: 2083-2092
- 7 Richeldi L, Du Bois RM, Raghu G. et al. Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis. N Engl J Med 2014; 370: 2071-2082
- 8 Behr J, Günther A, Bonella F. et al. S2k-Leitlinie Idiopathische Lungenfibrose – Update zur medikamentösen Therapie 2017. Pneumologie 2017; 71: 460-474
- 9 Albera C, Costabel U, Fagan EA. et al. Efficacy of pirfenidone in patients with idiopathic pulmonary fibrosis with more preserved lung function. Eur Respir J 2016; 48: 843-851
- 10 Collard HR, Richeldi L, Kim DS. et al. Acute exacerbations in the INPULSIS trials of nintedanib in idiopathic pulmonary fibrosis. Eur Respir J 2017; 49
- 11 Costabel U, Albera C, Lancaster LH. et al. An Open-Label Study of the Long-Term Safety of Pirfenidone in Patients with Idiopathic Pulmonary Fibrosis (RECAP). Respiration 2017; 94: 408-415
- 12 Lancaster L, Albera C, Bradford WZ. et al. Safety of pirfenidone in patients with idiopathic pulmonary fibrosis: integrated analysis of cumulative data from 5 clinical trials. BMJ Open Respir Res 2016; 3: e000105
- 13 Crestani B, Huggins JT, Kaye M. et al. Long-term safety and tolerability of nintedanib in patients with idiopathic pulmonary fibrosis: results from the open-label extension study, INPULSIS-ON. The Lancet Respiratory Medicine 2019; 7: 60-68
- 14 Richeldi L, Kreuter M, Selman M. et al. Long-term treatment of patients with idiopathic pulmonary fibrosis with nintedanib: results from the TOMORROW trial and its open-label extension. Thorax 2018; 73: 581-583
- 15 Kreuter M, Picker N, Schwarzkopf L. et al. Epidemiology, healthcare utilization, and related costs among patients with IPF: results from a German claims database analysis. Respir Res 2022; 23: 62
- 16 Dempsey TM, Payne S, Sangaralingham L. et al. Adoption of the Antifibrotic Medications Pirfenidone and Nintedanib for Patients with Idiopathic Pulmonary Fibrosis. Ann Am Thorac Soc 2021; 18: 1121-1128
- 17 Vancheri C, Kreuter M, Richeldi L. et al. Nintedanib with Add-on Pirfenidone in Idiopathic Pulmonary Fibrosis. Results of the INJOURNEY Trial. Am J Respir Crit Care Med 2018; 197: 356-363
- 18 Cottin V, Brown KK. Interstitial lung disease associated with systemic sclerosis (SSc-ILD). Respir Res 2019; 20: 13
- 19 Prasse A, Bonella F, Müller-Ladner U. et al. Therapie der systemischen Sklerose-assoziierten interstitiellen Lungenerkrankung. Z Rheumatol 2020; 79: 294-303
- 20 Distler O, Highland KB, Gahlemann M. et al. Nintedanib for Systemic Sclerosis-Associated Interstitial Lung Disease. N Engl J Med 2019; 380: 2518-2528
- 21 Acharya N, Sharma SK, Mishra D. et al. Efficacy and safety of pirfenidone in systemic sclerosis-related interstitial lung disease-a randomised controlled trial. Rheumatol Int 2020; 40: 703-710
- 22 Flaherty KR, Wells AU, Cottin V. et al. Nintedanib in Progressive Fibrosing Interstitial Lung Diseases. N Engl J Med 2019; 381: 1718-1727
- 23 Maher TM, Brown KK, Kreuter M. et al. Effects of nintedanib by inclusion criteria for progression of interstitial lung disease. Eur Respir J 2022; 59
- 24 Wells AU, Flaherty KR, Brown KK. et al. Nintedanib in patients with progressive fibrosing interstitial lung diseases – subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial. Lancet Resp Med 2020; 8: 453-460
- 25 Raghu G, Remy-Jardin M, Richeldi L. et al. Idiopathic Pulmonary Fibrosis (an Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2022; 205: e18-e47
- 26 Maher TM, Corte TJ, Fischer A. et al. Pirfenidone in patients with unclassifiable progressive fibrosing interstitial lung disease: a double-blind, randomised, placebo-controlled, phase 2 trial. The Lancet Respiratory Medicine 2020; 8: 147-157
- 27 Behr J, Prasse A, Kreuter M. et al. Pirfenidone in patients with progressive fibrotic interstitial lung diseases other than idiopathic pulmonary fibrosis (RELIEF): a double-blind, randomised, placebo-controlled, phase 2b trial. The Lancet Respiratory Medicine 2021; 9: 476-486
- 28 Wells AU. Pirfenidone in patients with non-IPF progressive fibrotic interstitial lung diseases: expert guidance is urgently needed. The Lancet Respiratory Medicine 2021; 9: 437-438
- 29 Ghazipura M, Mammen MJ, Bissell BD. et al. Pirfenidone in Progressive Pulmonary Fibrosis: A Systematic Review and Meta-Analysis. Ann Am Thorac Soc 2022; 19 (06) 1030-1039
- 30 Bendstrup E, Wuyts W, Alfaro T. et al. Nintedanib in Idiopathic Pulmonary Fibrosis: Practical Management Recommendations for Potenzial Adverse Events. Respiration 2019; 97: 173-184
- 31 Rodríguez-Portal JA. Efficacy and Safety of Nintedanib for the Treatment of Idiopathic Pulmonary Fibrosis: An Update. Drugs R D 2018; 18: 19-25