Nintedanib, a triple kinase inhibitor used to treat idiopathic pulmonary fibrosis (IPF), is tolerable in both elderly and nonelderly patients, according to the results of a new study published in PLOS One.

The researchers reviewed medical records on 65 elderly and nonelderly patients with IPF who were hospitalized between November 2015 and March 2020. They found that more elderly than nonelderly patients experienced adverse events associated with nintedanib administration, but the discontinuation rates due to adverse events were similar between the 2 patient groups.

“The continuation rates of nintedanib treatment at 6 months and 1 year in the elderly IPF group were equivalent,” the researchers wrote. “Furthermore, there was a similar trend in the reduction of the annual FVC [forced vital capacity] decline after nintedanib initiation between the groups.”


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Adverse events were experienced by 94.7% of the elderly patients and 71.7% of the nonelderly patients and primarily included diarrhea, nausea, and hepatic enzyme elevation. In the elderly patients, the duration of nintedanib dose reduction was shorter compared with the nonelderly patients, and the dose reduction may have been started at an earlier stage of the adverse events in these patients.

However, although adverse events occurred in a greater percentage of the elderly patients, the continuation rates between the elderly and nonelderly patients with IPF were similar. These results suggest that, if adverse events can be properly managed (including appropriate dose reduction), long-term therapy with nintedanib may be possible regardless of age.

Clinicians are often hesitant to prescribe antifibrotic drugs such as nintedanib due to the risk of adverse events. However, given the result of this study and the fact that nintedanib is recommended for the treatment of IPF in clinical guidelines, prolongs survival, and has been shown to reduce the decline in FVC in these patients, the authors recommend clinicians consider the therapy even for their elderly patients.

Reference

Komatsu M, Yamamoto H, Ichiyama T, et al. Tolerability of nintedanib in the elderly with idiopathic pulmonary fibrosis: a single-center retrospective study. PLOS One. 2022;17(2):e0262795. doi:10.1371/journal.pone.0262795