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Background <p>Nintedanib is approved for various interstitial lung diseases (ILDs). Although sarcopenia, which is characterized by a loss of skeletal muscle mass, is known to affect the outcome of ILD, the outcome of patients with sarcopenia receiving nintedanib remains unclear.</p> Methods <p>Fifty-six patients with ILD who were initiated on nintedanib between 2015 and 2023 were included. On CT images obtained prior to the introduction of nintedanib, the thoracic skeletal muscle area at the T4 level was measured to estimate the skeletal muscle index (SMI). Patients with an SMI in the lowest quartile were defined as the sarcopenia group, and the remaining patients as the non-sarcopenia group. The times from the start of nintedanib to all-cause death (overall survival: OS) and the first acute exacerbation (exacerbation-free survival: EFS) were compared between the two groups. Dose reduction and discontinuation rate of nintedanib were also evaluated. The cut-off date was determined to be 5&#xa0;years.</p> Results <p>Whereas age, sex, and serum levels of albumin and Klebs von den Lungen-6 did not differ between the two groups, forced vital capacity (%FVC) (63.7% vs. 72.7%), diffusing capacity of the lung for carbon monoxide (%DLco) (41% vs. 55.9%) and body mass index (20.6 vs. 25.2&#xa0;kg/m<sup>2</sup>) were significantly lower in the sarcopenia group (<i>n</i> = 14) than in the non-sarcopenia group (<i>n</i> = 42). The OS was significantly shorter in the sarcopenia group (26.5&#xa0;months vs. not reached, <i>P</i> = 0.03). Similarly, EFS was significantly shorter in the sarcopenia group (15.8 vs. 44.6&#xa0;months, <i>P</i> = 0.002). In the multivariate Cox proportional hazard models adjusted for age and sex, %FVC and baseline sarcopenia were significantly associated with OS (%FVC: hazard ratio (HR) 0.96, 95% confidence interval (CI) 0.93–0.98, <i>P</i> = 0.005, sarcopenia: HR 3.37, 95% CI 1.27–8.93, <i>P</i> = 0.01). Likewise, %FVC, %DLco and sarcopenia were significantly associated with EFS (%FVC: HR 0.96, 95% CI 0.93–0.98, <i>P</i> = 0.0004, %DLco: HR 0.96, 95% CI 0.94–0.98, <i>P</i> = 0.0006, sarcopenia. HR 2.79, 95% CI 1.23–6.34, <i>P</i> = 0.01). Although all patients in the sarcopenia group required a dose reduction or discontinuation of nintedanib, 21.5% of the non-sarcopenia group did not require such adjustments (<i>P</i> = 0.01).</p> Conclusions <p>Patients with sarcopenia and ILD may benefit less from nintedanib.</p>

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Sarcopenia affects the outcomes and tolerability in patients with interstitial lung disease receiving nintedanib: a retrospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月5日

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  • Toko Miura,
  • Tomonori Makiguchi,
  • Warabi Shibata,
  • Mizuki Hirata,
  • Masamichi Itoga,
  • Hisashi Tanaka,
  • Kageaki Taima,
  • Sadatomo Tasaka

摘要

Background

Nintedanib is approved for various interstitial lung diseases (ILDs). Although sarcopenia, which is characterized by a loss of skeletal muscle mass, is known to affect the outcome of ILD, the outcome of patients with sarcopenia receiving nintedanib remains unclear.

Methods

Fifty-six patients with ILD who were initiated on nintedanib between 2015 and 2023 were included. On CT images obtained prior to the introduction of nintedanib, the thoracic skeletal muscle area at the T4 level was measured to estimate the skeletal muscle index (SMI). Patients with an SMI in the lowest quartile were defined as the sarcopenia group, and the remaining patients as the non-sarcopenia group. The times from the start of nintedanib to all-cause death (overall survival: OS) and the first acute exacerbation (exacerbation-free survival: EFS) were compared between the two groups. Dose reduction and discontinuation rate of nintedanib were also evaluated. The cut-off date was determined to be 5 years.

Results

Whereas age, sex, and serum levels of albumin and Klebs von den Lungen-6 did not differ between the two groups, forced vital capacity (%FVC) (63.7% vs. 72.7%), diffusing capacity of the lung for carbon monoxide (%DLco) (41% vs. 55.9%) and body mass index (20.6 vs. 25.2 kg/m2) were significantly lower in the sarcopenia group (n = 14) than in the non-sarcopenia group (n = 42). The OS was significantly shorter in the sarcopenia group (26.5 months vs. not reached, P = 0.03). Similarly, EFS was significantly shorter in the sarcopenia group (15.8 vs. 44.6 months, P = 0.002). In the multivariate Cox proportional hazard models adjusted for age and sex, %FVC and baseline sarcopenia were significantly associated with OS (%FVC: hazard ratio (HR) 0.96, 95% confidence interval (CI) 0.93–0.98, P = 0.005, sarcopenia: HR 3.37, 95% CI 1.27–8.93, P = 0.01). Likewise, %FVC, %DLco and sarcopenia were significantly associated with EFS (%FVC: HR 0.96, 95% CI 0.93–0.98, P = 0.0004, %DLco: HR 0.96, 95% CI 0.94–0.98, P = 0.0006, sarcopenia. HR 2.79, 95% CI 1.23–6.34, P = 0.01). Although all patients in the sarcopenia group required a dose reduction or discontinuation of nintedanib, 21.5% of the non-sarcopenia group did not require such adjustments (P = 0.01).

Conclusions

Patients with sarcopenia and ILD may benefit less from nintedanib.