Team: INBUILD, aka “OFEVolution”

Base Article: Flaherty KR, Wells AU, Cottin V, et al. Nintedanib in Progressive Fibrosing Interstitial Lung Diseases. N Engl J Med. 2019;381(18):1718-1727. doi:10.1056/NEJMoa1908681

Authors: Ochsner Rheumatology Fellowship Program

1. Alexandra Reese, MD, first year rheumatology fellow at Ochsner Medical Center
2. Chandana Keshavamurthy, MBBS, MD, FACR, Associate Program Director at Ochsner Medical Center
3. Robert Quinet, MD, FACR, Program Director at Ochsner Medical Center
4. William Davis, MD, FACR, Department Head, Rheumatology
   Vice Chair of Education, Department of Internal Medicine at Ochsner Medical Center

Team Overview

The INBUILD trial is a multinational, randomized, double-blind, placebo-controlled, parallel-group trial that studied the efficacy and safety of an antifibrotic drug, nintedanib (OFEV ). Nintedanib is a multitargeted intracellular tyrosine kinase inhibitor that inhibits the critical pathways involved in the progression of lung fibrosis. Like in a FIFA league, 153 sites from 15 countries joined together to fight this disease in patients who were progressively declining despite treatment; specifically, these patients had already lost > 10% of their lung volume despite being on immunosuppressants. In patients with progressive fibrosing ILD from autoimmune causes, nintedanib slowed the decline in lung function. Nintedanib effectively won the Premier League when it gained approval for IPF, the FA Cup when it got approved for systemic sclerosis-ILD, and now the Champions League! It works in unclassifiable ILDs, autoimmune ILDs, chronic hypersensitivity pneumonitis, sarcoidosis, myositis, Sjogren’s syndrome, coal workers pneumoconiosis, and idiopathic forms of interstitial pneumonia such as idiopathic non-specific interstitial pneumonia. Because of the INBUILD trial, we are seeing nintedanib BUILT into treatment plans for our rheumatologic patients suffering from fibrosing ILD. Have you heard of the magic number in sports? Well, our magic number is 57, since the drug slowed lung function decline by 57% yearly compared to the placebo. This medication is breathing life into our patients who were previously left without many options. A warm EMBRACE while gazing at the NORT-STAR is lovely, but feeling like you can breathe, stay active and INBUILD your dreams is much better!

Want to learn more?

See the Q&A on theMednet.org about the following question: Do you generally recommend starting nintedanib prior to immunosuppressive therapy in a patient with CTD-ILD?

Next report: SAPHYR

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