Nintedanib is used for treatment of lung fibrosis (interstitial lung disease). This medication works by blocking biological pathways leading to fibrosis (thickening or scarring of the tissue) and does not reduce the strength of the body’s immune system. It was initially approved for treatment of a lung condition called idiopathic pulmonary fibrosis (IPF). Subsequently, it has been approved for slowing the progression of lung fibrosis in patients with systemic sclerosis (scleroderma), as well as those with other rheumatologic disease who have progressive lung fibrosis (progressive fibrosing interstitial lung disease). This medication can be used alone or in combination with other medications used for treatment of lung fibrosis such as mycophenolate. The effectiveness of nintedanib for treatment of fibrosis in other organs such as skin thickening is not established.
It typically takes approximately six months to see an impact of nintedanib on lung volumes as assessed by pulmonary function testing.
Nintedanib is an oral capsule and is typically taken twice daily. It comes in two strengths (150 mg and 100 mg). The target dose is 150 mg twice daily, but it can also be taken at lower dose if your health care provider believes this may be a better option due to another reason such as adverse effects or laboratory abnormalities.
Nintedanib should be avoided in patients with moderate to severe liver disease. Blood tests for liver enzymes should be obtained at the start of medication and regular intervals during the first 3 months of treatment.
Diarrhea is a common side effect. This side effect can be managed in most patients with usage of anti-diarrhea medications, decrease in nintedanib dose, or temporary stopping nintedanib. Other gastrointestinal side effects such as abdominal pain and nausea can also occur. As rheumatologic diseases such as systemic sclerosis (scleroderma) can themselves lead to gastrointestinal symptoms, disease related causes should also be considered and treated.
Nintedanib is not safe during pregnancy or breastfeeding. Patients who may become pregnant should use highly effective contraception during therapy and for ≥3 months after the last dose.
You should contact your rheumatology provider if you develop diarrhea or other gastrointestinal symptoms on nintedanib. Moreover, your rheumatology provider should be notified if your blood tests indicate elevation of liver enzymes.
If you are pregnant or considering pregnancy, let your rheumatology provider know before starting this medication. Women should discuss birth control with their primary care physicians or gynecologists before starting the medication. Breast-feeding should be avoided while taking this medication.
Written and approved July 2022 by the American College of Rheumatology Committee on Communications and Marketing.
This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.