How will you incorporate nerandomilast into your treatment algorithm for autoimmune ILD with progression, particularly relative to sequencing with immunosuppression?

This really depends on the subtype of connected tissue disease as well as radiographic pattern. I think for anyone who requires an anti-fibrotic, nerandomilast should be considered given its excellent tolerance. A caveat is that the FIBRONEER-ILD trial excluded cyclophosphamide, toci, MMF, rituximab...

The sequencing of therapy in CTD-related PPF remains unclear. Recent data suggest that immunosuppression may not alter clinical outcomes in fibrotic ILDs, including those associated with systemic autoimmune disorders (Pugashetti et al., PMID 42432856). In the FIBRONEER-ILD study, nerandomilast impro...

All current ILD guidelines suggest initiating therapy with immunosuppression and then adding an antifibrotic IF there is evidence for progression of fibrosis. This is based on low-quality evidence and driven by not only a lack of quality data but also cost and common side effects. Two of the guideli...