Nintedanib in Progressive Fibrosing Interstitial Lung Diseases (INBUILD)

Many non-IPF ILDs (hypersensitivity pneumonitis, CTD-ILD, sarcoidosis, etc.) can develop a progressive fibrosing phenotype with ongoing FVC decline despite treatment. INBUILD tested nintedanib in this broader population.

Multicenter RCT (n=663) comparing nintedanib 150 mg BID vs. placebo in patients with progressive fibrosing ILD (non-IPF) over 52 weeks.

Nintedanib reduced the annual rate of FVC decline (−80.8 vs −187.8 ml/year, p<0.001) across all ILD subtypes. Benefit was consistent regardless of HRCT pattern (UIP vs non-UIP).

Nintedanib is FDA-approved for progressive fibrosing ILD (non-IPF) including CTD-ILD, HP, and others with progressive phenotype. This expanded the antifibrotic indication beyond IPF. Identify progressive fibrosing ILD by: FVC decline ≥5% in 24 months + worsening symptoms/HRCT.

Heterogeneous ILD population. Underlying ILD-specific treatments were not standardized.