A group of international respiratory experts has called for action on the development of a treatable traits strategy for the management of interstitial lung diseases (ILDs), given that treatment options remain “scarce”.
The authors argue that a treatable traits approach in ILD is now a “clinical and research priority” to help improve treatment outcomes for patients.
Writing in The Lancet Respiratory Medicine, they highlighted evidence suggesting that despite differences in ILD subtypes there are common pathways “potentially amenable” to similar treatment strategies.
Such evidence “points to the existence of treatable traits – specific disease characteristics that are clinically relevant and modifiable through pharmacological or non-pharmacological interventions – that cut across traditional diagnostic categories,” they wrote.
They also outlined several potential treatable traits for ILD which fall into four key categories: causes, including drug use and genetics; lifestyle factors, including smoking and treatment adherence; pulmonary traits, such as progressive fibrosis and inflammation; and co-morbidities, including congestive heart failure and pulmonary hypertension.
According to the authors, progressive pulmonary fibrosis provides a solid example of a phenotype for which a treatable traits strategy could be viable, because of the “clinical similarities” seen across the spectrum of non-IPF ILDs, suggesting that they might share underlying pathobiological mechanisms and could therefore respond to similar treatments.
Moreover, in patients with progressive pulmonary fibrosis, the antifibrotic nintedanib has been shown to cut the rate of disease progression by slowing lung function decline, regardless of ILD diagnosis, they said, as most recently shown by the first ‘real-world’ data on its use in the UK (see our story on it here )
“Notably, molecular pathways targeted by nintedanib are overexpressed to a similar magnitude in lung tissue from several ILDs, regardless of their cause,” the authors said. “However, the majority of treatable traits in ILDs are based on phenotype, and several studies are underway to stratify patients according to clinically relevant endotypes,” they added.
As such, “moving from a disease-centred to a personalised management approach that is based on specific treatable traits through improved understanding of ILD biomarkers is a current priority,” they stressed, and called for “collaboration between the respiratory research community, regulatory agencies, and the pharmaceutical and biotech industries” to accelerate progress.
“Treatment practices are generally slow to change, but we believe that a treatable traits approach should be advanced in clinical practice, with steps to understand and overcome institutional, physician- centred, and patient-centred barriers to implementation,” they concluded.