Role of antifibrotics in the management of idiopathic inflammatory myopathy associated interstitial lung disease. (December 2021)

• Record Type: Journal Article
• Authors: Wilfong, Erin M.; Aggarwal, Rohit
• Is Part Of: Therapeutic advances in musculoskeletal disease. Volume 13(2021)
• Publication Date: 2021-12
• Subjects: antifibrotic therapies -- antisynthetase syndrome -- dermatomyositis -- idiopathic inflammatory myopathies -- interstitial lung disease -- polymyositis; Musculoskeletal system -- Diseases -- Periodicals; Musculoskeletal Diseases -- Periodicals; 616.7
• DOI: 10.1177/1759720X211060907
• Languages: English
• ISSNs: 1759-720X

Abstract

The antifibrotic therapies nintedanib and pirfenidone were first approved by the United States for the treatment of idiopathic pulmonary fibrosis in 2014. In 2020, nintedanib received U.S. Food and Drug Administration (FDA) approval for the treatment of all progressive fibrosing interstitial lung disease (ILD). Given that a major cause of mortality and morbidity in the idiopathic inflammatory myopathies (IIM) is progressive interstitial lung disease and respiratory failure, antifibrotic therapies may be useful as adjuvant to traditional immunosuppression. However, randomized controlled trials of antifibrotic therapies in IIM are lacking. The purpose of this review is to (1) summarize the mechanism of action of nintedanib and pirfenidone in ILD with possible role in IIM-ILD, (2) review the clinical data supporting their use in interstitial lung disease in general, and more specifically in connective tissue disease associated ILD, and (3) discuss the evidence and remaining challenges for using antifibrotic therapies in IIM-ILD.