Boehringer Ingelheim Pharmaceuticals announced the presentation of new analyses on the use of Ofev (nintedanib) in treating idiopathic pulmonary fibrosis (IPF) at the 2017 American Thoracic Society (ATS) conference.
Pooled data from the two Phase III INPULSIS trials showed that Ofev-treated patients were twice as likely as those given placebo to experience an improvement or no decline in lung function, as measured by forced vital capacity (FVC), at week 52 (36.8%, Ofev vs. 18.0%, placebo). A subgroup analysis of the open-label INPULSIS-ON study demonstrated a similar annual rate of FVC decline over 96 weeks among Ofev-treated patients, regardless of the dosage they received based on individual tolerability (150 mg twice daily, 100 mg twice daily, or both doses).
Additionally, a pooled analysis from the TOMORROW, and INPULSIS trials assessed the incidence rates for major adverse cardiovascular events (MACE) among patients treated with Ofev and placebo. Most patients included in this analysis (90%) had a high cardiovascular (CV) risk at baseline, including a history of fatty-plaque build-up in the arteries (called atherosclerosis) and/or at least one CV risk factor such as high blood pressure, diabetes or elevated blood cholesterol levels. Overall, the incidence of MACE was similar between the treatment groups both in patients with a high CV risk (3.5%, Ofev vs. 3.3%, placebo) and low CV risk (4.5%, Ofev vs. 5.3%, placebo) at baseline.
"IPF is a progressive disease that requires ongoing treatment. So, it is important to assess the long-term efficacy and safety of IPF treatments like Ofev to ensure we are maintaining lung function and reducing disease progression while not exacerbating co-existing conditions," Imre Noth, M.D., professor of medicine and director of the Interstitial Lung Disease Program at the University of Chicago said. "These new data help to further strengthen the science supporting the efficacy and safety of Ofev for up to 96 weeks of treatment, and offer physicians additional evidence to support their treatment decisions."
A separate analysis presented at ATS examined data from the IPF-PRO patient registry at 18 pulmonary care sites to identify the clinical characteristics of IPF patients who have advanced lung function impairment. Most clinical studies have included IPF patients with mild to moderate lung function impairment, and investigators wanted to understand how patients with more advanced disease differed. Patients with advanced IPF at baseline had greater physical impairment versus patients with mild to moderate disease, including lower six-minute walk distance (320 feet vs. 397 feet). The more advanced IPF patients also had an increased prevalence of hypoxemia (low blood oxygen), both at rest (36.6% vs. 7.4%) and while active (62.4% vs. 20.2%), requiring more supplemental oxygen, as well as a history of pulmonary arterial hypertension, or high blood pressure in the lungs (14.0% vs. 6.4%). In addition, health-related quality of life (HRQL) scores were significantly worse in those with advanced lung function impairment.
Ongoing research is being conducted for the treatment of Ofev in patients with IPF and other interstitial lung diseases. Nintedanib is also being investigated for the treatment of systemic sclerosis with associated interstitial lung disease (SSc-ILD), as well as progressive fibrosing interstitial lung disease (PF-ILD). Additionally, the first Phase IV trial following the approval of Ofev for the treatment of IPF is completed and will add evidence to the safety and tolerability of nintedanib in combination with pirfenidone. Results from the 12-week, randomized INJOURNEY trial will be presented at an upcoming international medical congress.
IPF is a rare and serious lung disease that causes permanent scarring of the lungs. It affects as many as 132,000 Americans, typically men over the age of 65.
INPULSIS-1 and -2 are two global Phase III trials which evaluated the efficacy and safety of nintedanib in the treatment of idiopathic pulmonary fibrosis (IPF). The INPULSIS trials were identical in design, e.g., with matching dosing, inclusion criteria and endpoints. INPULSIS recruited a range of patient types – similar to those seen in clinical practice including patients with early disease (FVC > 90% pred), no honeycombing on HRCT and/or concomitant emphysema. Patients who completed the 52-week treatment period and a 4-week follow-up period in the INPULSIS trials were offered open-label treatment with Ofev as part of an extension trial to assess the long-term safety and tolerability of Ofev. The INPULSIS-ON (Clinicaltrial.gov trial identifier: NCT01619085) trial included 734 patients and is currently ongoing.