Lung ultrasound and high-resolution computed tomography quantitative variations during nintedanib treatment for systemic sclerosis-associated interstitial lung disease

Marco Di Battista; Andrea Delle Sedie; Chiara Romei; Laura Tavanti; Mattia Da Rio; Riccardo Morganti; Alessandra Della Rossa; Marta Mosca

doi:10.1093/rheumatology/kead642

Lung ultrasound and high-resolution computed tomography quantitative variations during nintedanib treatment for systemic sclerosis-associated interstitial lung disease

Rheumatology (Oxford). 2023 Dec 4:kead642. doi: 10.1093/rheumatology/kead642. Online ahead of print.

Authors

Marco Di Battista^{1

2}, Andrea Delle Sedie¹, Chiara Romei³, Laura Tavanti⁴, Mattia Da Rio¹, Riccardo Morganti⁵, Alessandra Della Rossa¹, Marta Mosca¹

Affiliations

¹ Rheumatology Unit, University of Pisa, Pisa, Italy.
² Department of Medical Biotechnologies, University of Siena, Siena, Italy.
³ Radiology Unit, University of Pisa, Pisa, Italy.
⁴ Cardiovascular Thoracic Department, University of Pisa, Pisa, Italy.
⁵ Section of Statistics, University of Pisa, Pisa, Italy.

PMID: 38048612
DOI: 10.1093/rheumatology/kead642

Abstract

Objectives: Lung ultrasound (LUS) and high-resolution computed tomography (HRCT) are commonly used for the evaluation of interstitial lung disease (ILD). Nintedanib (NIN) is an antifibrotic therapy approved for systemic sclerosis-associated ILD (SSc-ILD). We assessed LUS and quantitative HRCT changes in SSc-ILD patients treated with NIN during a one-year follow-up, evaluating relationships between imaging variations and functional or quality-of-life outcomes.

Methods: SSc-ILD patients who started NIN were enrolled and followed for twelve months. Pulmonary function tests and patient-reported outcome measures (PROMs) were assessed half-yearly and quarterly, respectively. LUS was performed quarterly evaluating the presence of B-lines (BL) and pleural line irregularities (PLI). HRCT was repeated after one year and quantitatively analysed with CALIPER software.

Results: Ten patients (70% female, mean age 62 years) were enrolled. The mean total number of both BL and PLI was constantly decreased during NIN treatment, being significantly reduced after twelve months (from 175.1 ± 66.7-120.8 ± 70.3 for BL, p= 0.005 and from 50.6 ± 32.5-37.2 ± 22.4 for PLI, p= 0.05). Male gender, smoking habit and baseline forced vital capacity <70% predicted were associated with worse LUS outcomes. A greater reduction of both BL and PLI was observed in those who improved in PROMs, especially modified Medical Research Council dyspnoea scale (p= 0.016 and p= 0.04, respectively) and Saint George's Respiratory Questionnaire (p= 0.006 and p= 0.026, respectively). No significant changes in the CALIPER percentages of normal parenchyma or ILD elements were observed after twelve months of NIN, thus paralleling the stabilization obtained at pulmonary function tests.

Conclusions: We present preliminary results on NIN effects on SSc-ILD as assessed by LUS, a useful method for frequently repeated monitoring, and CALIPER, a valid implementation whenever a HRCT is performed.

Keywords: Interstitial lung disease; Lung ultrasound; Nintedanib; Quantitative HRCT; Systemic sclerosis.