Pharmacological management of progressive-fibrosing interstitial lung diseases: A review of the current evidence

Luca Richeldi, Francesco Varone, Miguel Bergna, Joao de Andrade, Jeremy Falk, Robert Hallowell, Stéphane Jouneau, Yasuhiro Kondoh, Lee E. Morrow, Winfried Randerath, Mary Strek, Gabriela Tabaj

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Abstract

A proportion of patients with interstitial lung diseases (ILDs) are at risk of developing a progressive-fibrosing phenotype, which is associated with a deterioration in lung function and early mortality. In addition to idiopathic pulmonary fibrosis (IPF), fibrosing ILDs that may present a progressive phenotype include idiopathic nonspecific interstitial pneumonia, connective tissue disease-associated ILDs, hypersensitivity pneumonitis, unclassifiable idiopathic interstitial pneumonia, ILDs related to other occupational exposures and sarcoidosis. Corticosteroids and/or immunosuppressive therapies are sometimes prescribed to patients with these diseases. However, this treatment regimen may not be effective, adequate on its own or well tolerated, suggesting that there is a pressing need for efficacious and better tolerated therapies. Currently, the only approved treatments to slow disease progression in patients with IPF are nintedanib and pirfenidone. Similarities in pathobiological mechanisms leading to fibrosis between IPF and other ILDs that may present a progressive-fibrosing phenotype provide a rationale to suggest that nintedanib and pirfenidone may be therapeutic options for patients with the latter diseases. This review provides an overview of the therapeutic options currently available for patients with fibrosing ILDs, including fibrosing ILDs that may present a progressive phenotype, and explores the status of the randomised controlled trials that are underway to determine the efficacy and safety of nintedanib and pirfenidone.

Original languageEnglish (US)
Article number180074
JournalEuropean Respiratory Review
Volume27
Issue number150
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

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All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine

Cite this

Richeldi, L., Varone, F., Bergna, M., de Andrade, J., Falk, J., Hallowell, R., Jouneau, S., Kondoh, Y., Morrow, L. E., Randerath, W., Strek, M., & Tabaj, G. (2018). Pharmacological management of progressive-fibrosing interstitial lung diseases: A review of the current evidence. European Respiratory Review, 27(150), [180074]. https://doi.org/10.1183/16000617.0074-2018