Prognostic factors in patients with interstitial lung disease treated with nintedanib: a multicenter retrospective study in Japan

Nintedanib is widely used to slow disease progression and prevent acute exacerbations in patients with idiopathic pulmonary fibrosis (IPF) and progressive fibrosing interstitial lung disease (PF-ILD). We retrospectively analysed patients who initiated nintedanib for IPF or PF-ILD between August 2019 and July 2023 across 15 institutions in Japan, focusing on prognosis and disease progression. Patients were divided into two groups based on whether they survived for ≥ 3 years after nintedanib initiation, and their characteristics were compared. We also evaluated factors associated with annual forced vital capacity (FVC) decline and acute exacerbations. A total of 413 patients (171 with IPF and 242 with PF-ILD) were included. Median survival was 1,177 days for IPF and 1,268 days for PF-ILD, with no significant difference (P = 0.20). Patients surviving < 3 years were older (75.0 vs. 71.0 years), more frequently had resting arterial oxygen saturation (SpO2) < 95% (44.5% vs. 18.0%), and lower body mass index (BMI) (21.9 vs. 24.1 kg/m2). Additionally, patients with a BMI < 22 kg/m2 showed greater annual relative FVC decline. In conclusion, patients with IPF and PF-ILD showed comparable outcomes following nintedanib treatment. Age ≥ 65 years, resting SpO2 < 95%, and BMI < 22 kg/m2 were associated with shorter survival after nintedanib initiation.