Quantitative Computed Tomography in Progressive Pulmonary Fibrosis: Data from a Sub-Study of the Double Blind, Randomized, Placebo-controlled INBUILD Trial
In brief
Nintedanib reduced CT-measured lung disease progression by 7% to 8%
In a 474-patient INBUILD trial sub-study, nintedanib reduced worsening in two quantitative CT measures by 7% to 8% versus placebo at 24 and 52 weeks. Higher CT scores at baseline also tracked with faster lung-function decline and greater risk of major decline or death. These imaging measures could help assess progression and treatment effects, but their value in guiding patient care remains unknown.
- Journal
- American journal of respiratory and critical care medicine (Q1)
- Published
- 29 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Anand Devaraj, Peter M George, Olivier Joly, Jonathan Goldin, Eric S White, Carina Ittrich, et al.
- PMID
- 42809243
- DOI
- 10.1093/ajrccm/aamag526
Why clinicians should know about it
- Picked for Pulmonary and Respiratory Medicine (paper of the day, 30 September 2026): Nintedanib slows quantitative CT progression
Abstract
RATIONALE: Change in forced vital capacity (FVC) is an established endpoint in clinical trials in lung fibrosis, but more sensitive measures of structural deterioration are needed. Quantitative computed tomography (QCT) measurements predict FVC decline and mortality, but more information is needed on their prognostic value and response to therapy. OBJECTIVES: Evaluate the prognostic potential of quantitative CT measurements derived using University of California Los Angeles (UCLA) and e-Lung (Brainomix) algorithms, and effects of nintedanib on these measurements, in patients with progressive pulmonary fibrosis (PPF). METHODS: Among patients with PPF in a sub-study of the INBUILD trial (N = 474), associations between UCLA quantitative ILD and lung fibrosis (QILD and QLF) scores, e-Lung total disease extent (TDE), reticulovascular score (RVS), and weighted RVS, and ILD progression were assessed. MEASUREMENTS AND MAIN RESULTS: In the placebo group, higher baseline QCT scores were associated with a greater rate of decline in FVC (mL/year) over 52 weeks. The risk of decline in FVC % predicted ≥10% or death over 52 weeks was greater with QCT scores above vs below the median; differences in restricted mean survival time ranged from 40-65 days. Nintedanib had significant effects on changes in QILD score and e-Lung TDE at week 24 (relative difference versus placebo [%]: -7 [95% CI: -11, -2; p = 0.005] and -8 [-12, -4; p < 0.001], respectively) and week 52 (-7 [-12, -2; p < 0.05] for both). CONCLUSIONS: Quantitative CT methods can facilitate prediction of progression and assessment of the efficacy of drugs in clinical trials in patients with PPF.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.