A 62-year-old woman with IPF has been on nintedanib for 8 months. Her FVC decline over 12 months was 180 mL (>100 mL decline = clinically significant). Which statement about nintedanib's mechanism in IPF is correct?

• A Nintedanib is an antifibrotic that blocks TGF-β receptor directly
• B Nintedanib inhibits tyrosine kinases including VEGFR, PDGFR, and FGFR, slowing FVC decline ✓
• C Nintedanib reverses existing fibrosis by activating matrix metalloproteinases
• D Nintedanib acts by blocking IL-13 signalling in alveolar macrophages

Explanation

Nintedanib is a triple angiokinase tyrosine kinase inhibitor (VEGFR-1/2/3, PDGFR-α/β, FGFR-1/2/3) that slows IPF progression by inhibiting fibroblast proliferation and differentiation. In the INPULSIS trials, nintedanib reduced annual FVC decline by ~125 mL compared to placebo. It does not reverse fibrosis. Pirfenidone acts via TGF-β modulation; anti-IL-13 therapies (e.g., tralokinumab) were investigated but not established for IPF.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.