0247: Use of Nintedanib in Patients with Progressive Pulmonary Fibrosis

Background/Purpose: Nintedanib was approved in the US for the treatment of chronic fibrosing interstitial lung diseases (ILDs) with a progressive phenotype (progressive pulmonary fibrosis [PPF]) in 2020. We used US claims data to evaluate the characteristics and treatment patterns of patients with PPF treated with nintedanib.

Methods: We analysed claims data from 2019 to 2022 in the Optum Clinformatics Data Mart database. PPF was identified based on ≥1 of these criteria: a) ≥2 encounters with ICD-10 diagnosis code for ‘interstitial lung disease with progressive fibrotic phenotype’, ≥1 to 365 days apart; b) fibrotic ILD (≥2 encounters with relevant ICD-10 diagnosis codes, ≥1 to 365 days apart) and a progressive fibrosing phenotype (met ≥1 proxy criterion for progression after diagnosis of fibrotic ILD). Patients with idiopathic pulmonary fibrosis were not included. Analyses were based on data from patients who were newly prescribed nintedanib after identification of PPF in 2020 or 2021. Patients were followed from nintedanib initiation until death, the end of continuous insurance coverage (30-day gap permitted), or the end of the study.

Results: Among the 333 patients newly prescribed nintedanib after identification of PPF in 2020 or 2021, mean age was 72 years; 55.9% were male; 65.5% were White; 81.7% had Medicare. The nintedanib dose at initiation was 150 mg twice daily in 74.8% of patients. Among the patients for whom information on provider was available, the provider at initiation of nintedanib was a pulmonologist in 72.8%, internist in 17.4%, a rheumatologist in 1.8%, a family practitioner in 0.9%, and a different provider in 7.0% of patients. Over a mean follow-up of 463 days, nintedanib was discontinued in 47.2% of patients and interrupted in 40.5% of patients. The mean time to first interruption or discontinuation of nintedanib was 134 days. The mean time between the first interruption and re-starting nintedanib was 34 days. After initiating nintedanib, oxygen therapy was prescribed for 72.1% of patients, systemic corticosteroids for 45.4%, mycophenolate for 13.2%, hydroxychloroquine for 6.9%, methotrexate for 2.4%, rituximab for 2.1%, and tocilizumab for 1.8%; 1.5% underwent lung transplantation. Among patients who initiated nintedanib, 79 (23.7%) died during the follow-up period.

Conclusion: This analysis of a claims database showed that among US patients with PPF prescribed nintedanib, comedication use was high, with 72.1% of patients later prescribed oxygen. Almost half of patients initiated on nintedanib discontinued it over a mean follow-up of about 15 months.