Skill Checkup: A 59-Year-Old Man With Dyspnea on Exertion and a Nonproductive Cough

Zab Mosenifar, MD


April 15, 2022

Antifibrotic therapies, which include TKIs, should be considered when patients on immunosuppressant therapy begin to develop either progressive changes pathophysiologically or on imaging that suggest fibrosis. These therapies should also be considered when there is a strong suspicion that the patient has a PF-ILD pattern.

Nintedanib is a triple TKI that has an antifibrotic effect. On the basis of the results of the 52-week INBUILD trial, a randomized phase 3 clinical trial, patients who received nintedanib had a slower rate of progression of ILD than those who received placebo, independent of the fibrotic pattern on high-resolution CT.

Tocilizumab is an IL-6 receptor antagonist approved for the treatment of various types of autoimmune arthritis and is also being investigated to treat systemic sclerosis. The prostacyclin vasodilator treprostinil is used to treat pulmonary hypertension associated with ILD.

TNF-α inhibitors have been hypothesized to increase the risk for ILD, including its most severe manifestation, pulmonary fibrosis.


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