Biomarkers and early treatment of idiopathic pulmonary fibrosis

The 2014 publication of the ASCEND 1 King Jr, TE Bradford WZ Castro-Bernardini S et al. A phase 3 trial of pirfenidone in patients with idiopathic pulmonary fibrosis. N Engl J Med. 2014; 370: 2083-2092 Crossref PubMed Scopus (2280) Google Scholar and INPULSIS 2 Richeldi L du Bois RM Raghu G et al. Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis. N Engl J Med. 2014; 370: 2071-2082 Crossref PubMed Scopus (2544) Google Scholar trials and subsequent regulatory approvals of pirfenidone and nintedanib, respectively, represented a watershed moment in the treatment of patients with idiopathic pulmonary fibrosis. The availability of efficacious therapies has prompted a new set of difficult questions related to when and how to initiate, alter, and discontinue antifibrotic therapy in patients with idiopathic pulmonary fibrosis. Effective therapy also enables investigation of predictors of treatment response to improve personalised care, and of biomarkers of treatment response that might inform treatment decisions and could broadly affect the approach to early-phase clinical trials in patients with idiopathic pulmonary fibrosis. Biomarkers of extracellular matrix turnover in patients with idiopathic pulmonary fibrosis given nintedanib (INMARK study): a randomised, placebo-controlled studyIn patients with idiopathic pulmonary fibrosis and preserved lung function, treatment with nintedanib versus placebo for 12 weeks did not affect the rate of change in CRPM but was associated with a reduced rate of decline in FVC. These results suggest that change in CRPM is not a marker of response to nintedanib in patients with idiopathic pulmonary fibrosis. Full-Text PDF