Current Treatment, Management Landscape for ILD

Dr Ross Summer describes the current treatment landscape for interstitial lung disease, as well as shares some insight on landmark clinical trials in part 2 of a video series.

This interview is a part of the video series “Inside Interstitial Lung Disease: Overall Burden, Therapy Options, & Looking Ahead.”

Read the full transcript:

My name is Ross Summer, and I am a physician scientist here at Thomas Jefferson University. I'm also the Section Chief of Pulmonary and Critical Care and the Director of the Interstitial Lung Disease Program at Thomas Jefferson University Hospital in Philadelphia.

What are the clinical goals you are looking for when treating patients with fibrosing interstitial lung diseases?

The clinical goals, just like with any disease when a physician cares for a patient, is to cure or eliminate the disease, but we all know that as providers and patients that that sometimes is not possible. And so then, we have secondary goals which is to slow down the progression of disease and to make people live with their disease better.

By slowing down the progression of disease, we have treatments that are targeted to specifically to the disease in the field of pulmonary fibrosis. There are several treatments for that. But in addition, there are other types of treatments such as rehab, getting people to dietitians, and doing other things to make you more functional with the disease that you have. There are treatments that come along secondary to the disease. In the case of pulmonary fibrosis, it may be oxygen therapy, or may be therapies for the heart because of the effects of the lung disease on the heart.

Can you discuss the current treatment landscape and offer some insight on the different agents and approaches available?

Over the last couple decades, we've learned a lot about pulmonary fibrosis, and we've come up with a lot of new treatments. I would say, the simplest way to think of it is that there's 2 buckets of treatments. There are the immunosuppressive treatments, and these are therapies that are targeting the immune system because in some forms of pulmonary fibrosis—it's actually the immune system that's targeting, attacking, and damaging the lung, and causing scar tissue. In those cases, what we do is try to dial down the immune system. Turn it down, so there's less injury to the lung and we allow the lung to heal itself.

The second buckets of treatment is called antifibrotic treatments, and these drugs try to slow down the progression of the scar tissue that sometimes accumulates in these diseases and causes a lot of the problems with gas exchange. These antifibrotics, in the beginning, were just designed for a few diseases in mind, but now, the indications for these have expanded enormously, and we are now using this for a big range of diseases.

Recent data, particularly from the IMPULSIS 1 and 2, INBUILD, and SENSCIS trials, demonstrated nintedanib successfully reduced lung function decline. Can you explain why this is significant?

The trials that were just mentioned were all landmark studies, and that means they were very important for the field of pulmonary fibrosis and they pushed the field forward to a large degree. The first two trials, IMPULSIS 1 and IMPULSIS 2, let doctors know that it is safe and effective to use nintedanib in treating patients with idiopathic pulmonary fibrosis. In fact, the drug was so effective, it reduced the decline in lung function by over 50%. Now that's standard of care in the treatment of that specific form of pulmonary fibrosis.

And then, came the INBUILD study which demonstrated that this drug is safe and effective and reduces the progression of the disease in almost all forms of progressive pulmonary fibrosis. So, not just idiopathic pulmonary fibrosis, but now, we're talking ones that come from the environment, the things we inhale into our lungs, as well as autoimmune diseases.

So, the third trial was the SENSCIS trial which was specific for a type of autoimmune disease called scleroderma. In this trial, it was again shown that the drug was safe and effective in treating this form of pulmonary fibrosis.

Collectively, all these trials really changed the field and now gave us a treatment for patients with all different types of pulmonary fibrosis, making it easier on the physician. Because before, we had to make sure we had the right diagnosis before we could give this treatment. Now, we can prescribe it on a broader level.

This transcript has been edited for clarity.