Nurhan ATİLLA, Gözde YILDIRIM ÇETİN, Burak OKYAR, Hüseyin ARPAĞ

Sistemik skleroz ilişkili interstisyel akciğer hastalığı ve nintedanib

Sistemik skleroz ile ilişkili interstisyel akciğer hastalığında (SSc-İAH) akciğer fibrozisine yol açan birçok mekanizma öne sürülmesine rağmen, bu konu henüz tam olarak anlaşılamamıştır. Son zamanlarda, idiyopatik pulmoner fibrozdan (İPF) sorumlu aracıların ve patolojik mekanizmaların SSc-İAH’dekilere benzer olduğuna dair kanıtlar artmıştır. Buna göre, İPF tedavisinde kullanılan antifibrotik ajanların SSc-İLD’de de faydalı olabileceğini destekleyen çalışmalar mevcuttur. Şu anda piyasada nintedanib ve pirfenidon olmak üzere iki antifibrotik ajan bulunmaktadır. SSc-İAH’de pirfenidon kullanımına ilişkin çalışmalar tatmin edici olmasa da, nintedanib çalışmaları olumlu sonuçlar vermiştir. SENSCIS (Safety and Efficacy of Nintedanib in Systemic Sclerosis) çalışması bu konudaki ilk ve en kapsamlı Faz III çalışmasıdır 2019’da SENSCIS çalışmasının sonuçları, nintedanib’in SSc-İAH’de akciğer fonksiyonundaki yıllık düşüşü önemli ölçüde azalttığını göstermiştir. Şiddetli akciğer fonksiyon kaybı olan SSc-İAH hastalarını içermeyen bu çalışmadan sonra, nintedanib dünya çapında SSc-İAH tedavisi için lisans almıştır. Bununla birlikte, şu anda mevcut olan literatür verileri, nintedanibin SSc-İAH üzerindeki uzun vadeli etkileri ve yan etkileri ve ayrıca ileri evre SSc-İAH üzerine etkilerinden yoksundur. Bu çalışmanın amacı, SSc-İAH’de nintedanib kullanımını güncel literatür eşliğinde, bu hastalığın patogenezinden de bahsederek gözden geçirmektir.

Anahtar Kelimeler:

Sistemik skleroz, nintedanib, akciğer, fibrozis

Systemic sclerosis related interstitial lung disease and nintedanib

Although many mechanisms leading to lung fibrosis in systemic sclerosis-associated interstitial lung disease (SSc-ILD) have been suggested, this issue has not been fully understood yet. Recently, there has been increased evidence that the mediators and pathological mechanisms responsible for idiopathic pulmonary fibrosis (IPF) are similar to those in SSc-ILD. Accordingly, studies have been conducted to support that antifibrotic agents used in the treatment of IPF may also be useful in SSc-ILD. There are currently two antifibrotic agents on the market, namely nintedanib and pirfenidon. Although studies on the use of pirfenidone in SSc-ILD are not satisfactory, nintedanib studies have yielded positive results. The SENSCIS (Safety and Efficacy of Nintedanib in Systemic Sclerosis) study is the first and most comprehensive Phase III study on this subject. In 2019, the results of SENSCIS trial showed that, nintedanib significantly reduced the annual decline in lung function in SSc-ILD. After this trial, which did not include SSc-ILD patients with severe lung function loss, nintedanib licenced for the treatment of SSc-ILD worldwide. However, the currently available literature data lacks information about long-term effects and side effects of nintedanibe on SSc-ILD an also about the advanced SSc-ILD. The aim of this study is to review SSc-ILD patients treated with nintedanib, by also mentioning the pathogenesis of this disease according to the current literature.

Keywords:

Sistemik skleroz, nintedanib, akciğer, fibrozis,

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