A 52-year-old woman is diagnosed with UIP pattern on HRCT — bilateral basal subpleural honeycombing with traction bronchiectasis. Surgical lung biopsy confirms usual interstitial pneumonia. Which antifibrotic drug has shown reduction in FVC decline in both IPF and progressive fibrotic ILD beyond IPF?
- A Pirfenidone
- B Azathioprine
- C Nintedanib ✓
- D N-acetylcysteine
Correct answer: C. Nintedanib
Explanation
Nintedanib (a tyrosine kinase inhibitor targeting PDGFR, VEGFR, FGFR) has demonstrated reduction in FVC decline in IPF (INPULSIS trial), systemic sclerosis-ILD (SENSCIS trial), and progressive fibrotic ILD of various causes (INBUILD trial). Pirfenidone has proven efficacy in IPF (ASCEND/CAPACITY trials) but data in non-IPF progressive fibrotic ILD is less robust. Azathioprine and N-acetylcysteine were shown to be harmful in IPF in the PANTHER-IPF trial. Nintedanib's breadth across ILD subtypes distinguishes it.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.