Tolerability and Safety of Nintedanib and Immunosuppression in Autoimmune Inflammatory Myopathy-Associated Progressive Pulmonary Fibrosis
Bibliographic record
Abstract
Background: Autoimmune-inflammatory myopathy-related interstitial lung diseases (AIM-ILDs) are often progressive and fibrotic. Given their rarity, little is known about the safety and tolerability of antifibrotic nintedanib in combination with immunosuppression in AIM-ILD. Research Question: Is the addition of nintedanib to immunosuppression safe and tolerable in patients with AIM-ILD, and does nintedanib administration induce peripheral blood cell gene expression changes? Study Design and Methods: This was a single-arm, open-label trial to assess safety and tolerability of nintedanib with immunosuppression. Patients with progressive, fibrotic AIM-ILD on background immunosuppression were given nintedanib for 24 weeks. The primary end point was the percentage of patients who took ≥ 90% study drug doses. The secondary end points included safety (adverse events) and efficacy (lung function) outcomes. Bulk RNA sequencing of peripheral blood was performed at baseline and each subsequent visit to examine gene expression. Results: A total of 11 participants were enrolled; of these, 9 completed the study visits as per protocol. The trial was discontinued due to slow recruitment. Three participants (27%) took ≥ 90% doses of nintedanib. Drug compliance ranged from 27% to 95%. The most common adverse events were diarrhea, nausea/vomiting, and abdominal pain. There were no overall significant changes in lung function, or difference in gene expression in peripheral blood over time identified. Interpretation: Tolerability of combined nintedanib and immunosuppression in AIM-ILD appears challenging. Nintedanib treatment did not induce measurable gene expression changes in peripheral blood. However, the study's small sample size, compounded by recruitment difficulties leading to early discontinuation, restricts the robustness and generalizability of the findings. Clinical Trial Registration: ClinicalTrials.gov; No.: NCT05335278; URL: www.clinicaltrials.gov.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".