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New perspectives in the treatment of child
Nintedanib is a tyrosine kinase inhibitor that interacts with key receptors involved in the regulation of crucial pathogenetic processes in pulmonary fibrosis. Therefore, it is approved for the treatment of adult Idiopathic Pulmonary Fibrosis. In pediatric patients, this therapeutic option has not yet been approved but could improve the landscape for children with interstitial lung disease.
The work of Deterding et al. describes to us the InPedILD study that sought to evaluate the safety and risk/benefit of using Nintedanib in children with fibrosing pulmonary interstitial disease detected by high-resolution computed tomography (HRTC) within 12 months prior to enrollment and age 6 to 17 years. The study was conducted in 21 different countries and involved randomized double-blind enrollment of 2 different groups (2:1 proportion): patients taking nintedanib for 24 weeks and patients taking a placebo. After this first phase passed, all the children took nintedanib. The starting dose was 59, 75, 100, 150 mg depending on weight twice a day and subsequently modified according to any side effects. Twenty-six patients were enrolled in the first group who took the drug immediately and 13 patients who took only placebo. The results show a safety profile with weight-calculated dosing in the use of Nintedanib in this age group: the main side effect presented was diarrhea but still in less frequency than in adults. Patients in the group taking the drug presented less decline in FVC in follow-up.
The study is certainly limited by the small numbers. However, it should be considered that the rarity of the condition, especially in pediatric age, does not make it easy to analyze much larger samples. Even with that limitation, this study paves the way toward the use of Nintedanib in pediatric age as well. More in-depth studies will have to follow to better define treatment regimens and indications for use.
BIBLIOGRAPHY
Deterding R, Young LR, DeBoer EM, Warburton D, Cunningham S, Schwerk N, Flaherty KR, Brown KK, Dumistracel M, Erhardt E, Bertulis J, Gahlemann M, Stowasser S, Griese M; InPedILD trial investigators. Nintedanib in children and adolescents with fibrosing interstitial lung diseases. Eur Respir J. 2023 Feb 2;61(2):2201512. doi: 10.1183/13993003.01512-2022. Print 2023 Feb.
