Which of the following is false?

Treatment with pirfenidone is indicated

Treatment with nintedanib is indicated

No treatment is indicated because of relatively preserved lung volumes (FVC: 97% predicted, TLC: 80% predicted)

No treatment is indicated because there is no definite honeycombing on HRCT and because there is no biopsy confirmed diagnosis

Author’s solution
A post hoc subgroup analyses of the INPULSIS clinical trial showed same effect of nintedanib on annual rate of decline in FVC, time to first acute exacerbation and change in SGRQ total score over 52 weeks in patients with preserved/marginally impaired lung function (FVC >90% predicted) vs patients with more impaired lung function (FVC< 90% predicted) and also in patients without honeycombing or biopsy vs patients with honeycombing and/or biopsy.1,2
Pooled data from the ASCEND and CAPACITY clinical trials showed similar treatment effects of pirfenidone on rate of decline in FVC and 6MWD, in patients  with baseline FVC ≥ 80% and GAP1 vs patients with baseline FVC < 80% or GAP2-3.3

Kolb M et al. Am J Respir Crit Care Med 191;2015:A1021.
Raghu G et al. Am J Respir Crit Care Med 191;2015:A1022.
Albera C et al. Am J Respir Crit Care Med 191;2015:A1018.


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