A 68-year-old woman with IPF (usual interstitial pneumonia on HRCT) has FVC 65% predicted and DLCO 42%. She has no significant cardiovascular comorbidity. The INPULSIS trials established which treatment benefit?
- A Pirfenidone significantly reduced all-cause mortality compared to placebo in IPF
- B Nintedanib reduced the rate of FVC decline by approximately 50 mL/year over 52 weeks ✓
- C N-acetylcysteine was equally effective to nintedanib for slowing FVC decline
- D Prednisone alone at 40 mg/day significantly reduced fibrotic progression in IPF
Correct answer: B. Nintedanib reduced the rate of FVC decline by approximately 50 mL/year over 52 weeks
Explanation
INPULSIS-1 and INPULSIS-2 (NEJM 2014) showed that nintedanib 150 mg twice daily significantly reduced the adjusted annual rate of FVC decline from approximately −223 mL/year (placebo) to −113 mL/year (nintedanib) — a 50% reduction. Neither trial showed mortality benefit individually, though meta-analysis is suggestive. Pirfenidone (CAPACITY, ASCEND trials) also slows FVC decline. N-acetylcysteine was shown ineffective in the PANTHER-IPF trial. Corticosteroids are contraindicated in IPF and may worsen outcomes.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.