Nintedanib (SSc-ILD)

How it works

It inhibits multiple tyrosine kinases including the platelet-derived, fibroblast and vascular endothelial growth factor receptors, attenuating fibroblast proliferation and the fibrotic processes that drive progressive lung scarring.

Prescribing in practice

• Diarrhoea is very common and can be severe enough to cause dehydration, so manage it promptly with hydration and antidiarrhoeals and adjust the dose as directed rather than stopping abruptly.
• It can cause hepatotoxicity, and because of its antiangiogenic action it raises the risk of bleeding, impaired wound healing and rare gastrointestinal perforation.
• It is teratogenic, so effective contraception is required for people of childbearing potential and it should be taken with food.

Monitoring

Monitor liver function before and during treatment and watch for gastrointestinal effects, bleeding and signs of dehydration.

Counselling the patient

• Take capsules with food and report troublesome diarrhoea early so it can be managed.
• Report yellowing of the skin, unusual bleeding or severe abdominal pain.
• Use effective contraception and tell the team before any planned surgery.

Evidence & guidelines

Nintedanib is approved and NICE-appraised for systemic sclerosis-associated and other progressive fibrosing interstitial lung diseases on the basis of trials showing reduced lung function decline.