Global landscape for pulmonary fibrosis treatment: a data-driven perspective from clinical trials

To systematically map the global landscape, evolution and key characteristics of interventional clinical trials in pulmonary fibrosis, providing an empirical basis for future trial strategies and resource allocation. The INFORMA Pharma Intelligence database was searched to identify 1,203 interventional PF trials. Descriptive statistics were applied to analyse temporal trends, geographic distribution, sponsors, trial phase and status, primary endpoints, drug targets or mechanisms, and the disease spectrum. Global pulmonary fibrosis trial activity displayed a three-stage growth pattern, with a surge in 2020. Research is highly concentrated geographically: the United States (316 trials) and China (285 trials) dominate, yet only 128 trials are multinational. The pipeline remains centred on nintedanib (94 trials) and pirfenidone (88 trials), while target diversity is expanding, especially toward anti-angiogenic and multi-tyrosine-kinase inhibitors. Primary endpoints focus on safety or tolerability and Forced Vital Capacity change. The disease spectrum has broadened from idiopathic pulmonary fibrosis to include Connective tissue disease-associated fibrosis. Pulmonary fibrosis clinical research is experiencing unprecedented dynamism and diversification, transitioning from targeted therapy towards precision and multimodal intervention. Enhanced international collaboration, optimized trial design, and deeper precision-based stratification will be critical to advancing the field from slowing disease progression to reversing tissue damage.