Efficacy and safety of Nintedanib for idiopathic pulmonary fibrosis: a meta-analysis / 中国实用内科杂志

ABSTRACT

OBJECTIVE: To systematically review the efficacy and safety of Nintedanib in patient with idiopathic pulmonary fibrosis.METHODS: We search systematically for randomized controlled trials and cohort study of Nintedanib for idiopathic pulmonary fibrosis patients published between January 1999 and May 2018. The literatures that met all eligibility criteria were selected. The extracted data were analyzed with RevMan 5.3. RESULTS: A total of 4 random control trials(RCT) and one cohort study were included. Nintedanib, as compared with placebo, reduced the decline in FVC and the predicted FVC% from baseline by 130 mL/yr or 3.84% of the mean value respectively. It also significantly reduced relative the risk of FVC%pred≥10% or FVE decline≥200 mL(RR 0.78, 95% confidence interval(CI) 0.67 to 0.90, P=0.0006), the hazard ratio(HR) of first acute exacerbation(HR with Nintedanib, 0.53; 95%CI 0.33-0.86;P=0.02), all-cause mortality(HR in the Nintedanib group, 0.70; 95%CI 0.45-1.08; P=0.11) and respiratory mortality(HR in the Nintedanib group, 0.63; 95%CI 0.37-1.10; P=0.11) in IPF patients. The Nintedanib group had a higher rate of gastrointestinal adverse events and a lower rate of cardiovascular events compared to the placebo group(P=0.02). CONCLUSION: Nintedanib delays disease progression in patients with IPF. Nintedanib is generally well tolerated, and the mild gastrointestinal adverse events are more common.