Would you consider the use of dual antifibrotic therapy (nintedanib and pirfenidone together) for progressive fibrosing ILD?

Pirfenidone and Nintedanib have different antifibrotic mechanisms of action, and emerging data suggests that these complex molecules may possess previously unknown pleiotropic properties. It is unclear whether a synergistic effect might be realized from combination therapy with these agents, and ind...

I don't think we are at a place where this should be routine practice. There are case reports of patient stabilization when a second antifibrotic is added, but I agree the best data we have are from INJOURNEY. There's also this from Flaherty et al., PMID 29946005 which is a bit longer but comes to s...

One of the difficulties of having to rely on surrogate endpoints for antifibrotic RCTs is that these important sequencing and combination questions are incredibly difficult to answer.

Clearly, in meta-analytic analyses, there is a mortality benefit from antifibrotic therapy but the n required to fin...

Never.

1. Costly therapies requiring separate approvals, and resource utilization limits make it impossible in real-world scenarios.
2. Each drug has SIGNIFICANT ramp-up side effects. If patients are unable to tolerate due to side effects, will be a situation difficult to separate the trigger agent from ...