Stability or improvement in forced vital capacity with nintedanib in patients with idiopathic pulmonary fibrosis

In the Phase III INPULSIS (R) trials, nintedanib reduced the annual rate of decline in forced vital capacity (FVC) versus placebo in patients with idiopathic pulmonary fibrosis (IPF). We conducted post hoc analyses of the distribution of changes in FVC in the INPULSIS (R) trials and FVC changes in the open-label extension trial INPULSIS (R)-ON in subgroups of patients based on whether patients had shown an improvement or no decline in FVC in INPULSIS (R). Analyses were descriptive. Based on the annual rate of change in FVC, 158 of 638 patients (24.8%) treated with nintedanib and 38 of 423 patients (9.0%) treated with placebo had an improvement/no decline in FVC in the INPULSIS (R) trials. In patients whose FVC improved/did not decline, median (interquartile range) improvements in FVC at week 52 were 76.5 (31-152) mL and 57.5 (31-103) mL in the nintedanib and placebo groups, respectively. Changes in FVC from baseline to week 48 of INPULSIS (R)-ON were similar in patients whose FVC improved or declined in the preceding INPULSIS (R) trial. In the INPULSIS (R) trials, treatment with nintedanib resulted in a greater proportion of patients with IPF showing an improvement/no decline in FVC compared to taking placebo. Mechanisms underlying improvement in FVC in patients with IPF are unknown.