No Benefit to Treating Idiopathic Pulmonary Fibrosis with Nintedanib and Sildenafil

The last 5 years have yielded advances in therapy for patients with idiopathic pulmonary fibrosis (IPF). Nintedanib (Ofev), a tyrosine kinase inhibitor, slows the rate of decline in lung function, albeit without improving dyspnea or quality of life (NEJM JW Gen Med Jul 1 2014 and N Engl J Med 2014; 370:2071). A recent trial suggested that pulmonary vasodilators might have more effects on symptoms, particularly for patients with IPF and associated right heart dysfunction (due to destruction of the capillary bed from fibrosis; Chest 2013; 143:1699).

Investigators randomized 274 patients with IPF and diffusion capacity for carbon monoxide (DL_CO) <35% of predicted to receive nintedanib plus either sildenafil or placebo. One third of patients had…