Estimating the addition clinical workload required for nintedinib treatment in PF-ILD

Abstract

The INBUILD study demonstrated a reduction in lung function decline in patients with progressive pulmonary fibrosis (PF-ILD) treated with the antifibrotic nintedanib. Consequently, it is now licenced in the UK for use in patients outwith the previous permitted indication (IPF). A review of new ILD referrals to UK specialist centres (Simpson et al, Eur Respir J, 2021) suggested that 14.5% would be eligible for treatment, but did not capture the number of existing patients under review that may also be eligible.

We reviewed our database of 314 non-IPF ILD patients to determine eligibility for nintedanib treatment (NHSE prescribing criteria, based on INBUILD criteria), using currently held data (documented symptom status, spirometry over the preceding 24 months and latest imaging) or after further assessment of these parameters.

We found that 25 (8%) of those with known PF-ILD are currently eligible for nintedanib, with a further 84 (26.7%) potentially eligible pending further assessment. Repeat CT imaging or reporting of fibrosis volume on existing scans is required in in 7 (2.2%) and 8 (2.5%) patients respectively. Current spirometry and symptom assessment is required in 38 (12.1%) and 31 (9.9%).

We demonstrate that as many as 35% of patients with non IPF-ILD could be eligible for nintedanib. The additional clinical burden required to identify, treat and monitor these patients is substantial, representing almost a doubling of our current antifibrotic caseload. It is important to recognise that there are an additional unknown number of potentially eligible patients with CTD-ILD, under rheumatology review, who previously would have not required referral to ILD clinics.