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Administration of nintedanib after discontinuation for acute exacerbation of idiopathic pulmonary fibrosis: a case report

BACKGROUND: Nintedanib is a multi-target receptor tyrosine kinase inhibitor. In two recent randomized phase 3 trials (INPULSIS™-1 and -2), it has been shown to slow the disease progression of idiopathic pulmonary fibrosis (IPF) by reducing the decline in the forced vital capacity (FVC). Although the...

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Autores principales: Ikeda, Satoshi, Sekine, Akimasa, Baba, Tomohisa, Yamakawa, Hideaki, Morita, Masato, Kitamura, Hideya, Ogura, Takashi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4778330/
https://www.ncbi.nlm.nih.gov/pubmed/26940352
http://dx.doi.org/10.1186/s12890-016-0201-9
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author Ikeda, Satoshi
Sekine, Akimasa
Baba, Tomohisa
Yamakawa, Hideaki
Morita, Masato
Kitamura, Hideya
Ogura, Takashi
author_facet Ikeda, Satoshi
Sekine, Akimasa
Baba, Tomohisa
Yamakawa, Hideaki
Morita, Masato
Kitamura, Hideya
Ogura, Takashi
author_sort Ikeda, Satoshi
collection PubMed
description BACKGROUND: Nintedanib is a multi-target receptor tyrosine kinase inhibitor. In two recent randomized phase 3 trials (INPULSIS™-1 and -2), it has been shown to slow the disease progression of idiopathic pulmonary fibrosis (IPF) by reducing the decline in the forced vital capacity (FVC). Although the INPULSIS™ trials indicate that nintedanib may serve to prevent acute exacerbations or delay the time to the first acute exacerbation, a certain number of IPF patients develop acute exacerbations while receiving nintedanib. However, there has been no report on the readministration of nintedanib in IPF patients who develop acute exacerbations during initial treatment with nintedanib. CASE PRESENTATION: A 64-year-old man with IPF had nintedanib added to his ongoing pirfenidone therapy. He developed dyspnea after 65 days and presented with hypoxemia after 68 days. At presentation, chest computed tomography showed newly developed diffuse ground glass opacities with the pre-existing subpleural reticular shadows. Because of the absence of infection or other potential causative factors, we diagnosed an acute exacerbation of IPF. Nintedanib was temporarily discontinued and the acute exacerbation was successfully managed with intensive treatment. We re-initiated nintedanib 30 days after cessation, which helped stabilize his FVC for 8 months. Nintedanib was safely continued for 28 months until he died of a bacterial infection. CONCLUSION: To the best of our our knowledge, this is the first reported case of an acute exacerbation of IPF during nintedanib treatment, wherein nintedanib was safely and successfully restarted after treatment of the acute exacerbation. Our case indicates that nintedanib can be safely resumed and a desired effect on FVC can be obtained, even in IPF patients who develop acute exacerbations. However, we recommend close monitoring and appropriate measures until the long-term safety profile is clarified.
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spelling pubmed-47783302016-03-05 Administration of nintedanib after discontinuation for acute exacerbation of idiopathic pulmonary fibrosis: a case report Ikeda, Satoshi Sekine, Akimasa Baba, Tomohisa Yamakawa, Hideaki Morita, Masato Kitamura, Hideya Ogura, Takashi BMC Pulm Med Case Report BACKGROUND: Nintedanib is a multi-target receptor tyrosine kinase inhibitor. In two recent randomized phase 3 trials (INPULSIS™-1 and -2), it has been shown to slow the disease progression of idiopathic pulmonary fibrosis (IPF) by reducing the decline in the forced vital capacity (FVC). Although the INPULSIS™ trials indicate that nintedanib may serve to prevent acute exacerbations or delay the time to the first acute exacerbation, a certain number of IPF patients develop acute exacerbations while receiving nintedanib. However, there has been no report on the readministration of nintedanib in IPF patients who develop acute exacerbations during initial treatment with nintedanib. CASE PRESENTATION: A 64-year-old man with IPF had nintedanib added to his ongoing pirfenidone therapy. He developed dyspnea after 65 days and presented with hypoxemia after 68 days. At presentation, chest computed tomography showed newly developed diffuse ground glass opacities with the pre-existing subpleural reticular shadows. Because of the absence of infection or other potential causative factors, we diagnosed an acute exacerbation of IPF. Nintedanib was temporarily discontinued and the acute exacerbation was successfully managed with intensive treatment. We re-initiated nintedanib 30 days after cessation, which helped stabilize his FVC for 8 months. Nintedanib was safely continued for 28 months until he died of a bacterial infection. CONCLUSION: To the best of our our knowledge, this is the first reported case of an acute exacerbation of IPF during nintedanib treatment, wherein nintedanib was safely and successfully restarted after treatment of the acute exacerbation. Our case indicates that nintedanib can be safely resumed and a desired effect on FVC can be obtained, even in IPF patients who develop acute exacerbations. However, we recommend close monitoring and appropriate measures until the long-term safety profile is clarified. BioMed Central 2016-03-03 /pmc/articles/PMC4778330/ /pubmed/26940352 http://dx.doi.org/10.1186/s12890-016-0201-9 Text en © Ikeda et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Ikeda, Satoshi
Sekine, Akimasa
Baba, Tomohisa
Yamakawa, Hideaki
Morita, Masato
Kitamura, Hideya
Ogura, Takashi
Administration of nintedanib after discontinuation for acute exacerbation of idiopathic pulmonary fibrosis: a case report
title Administration of nintedanib after discontinuation for acute exacerbation of idiopathic pulmonary fibrosis: a case report
title_full Administration of nintedanib after discontinuation for acute exacerbation of idiopathic pulmonary fibrosis: a case report
title_fullStr Administration of nintedanib after discontinuation for acute exacerbation of idiopathic pulmonary fibrosis: a case report
title_full_unstemmed Administration of nintedanib after discontinuation for acute exacerbation of idiopathic pulmonary fibrosis: a case report
title_short Administration of nintedanib after discontinuation for acute exacerbation of idiopathic pulmonary fibrosis: a case report
title_sort administration of nintedanib after discontinuation for acute exacerbation of idiopathic pulmonary fibrosis: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4778330/
https://www.ncbi.nlm.nih.gov/pubmed/26940352
http://dx.doi.org/10.1186/s12890-016-0201-9
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