Expert Call for Access Reform and Multidisciplinary Care in ILD Management

EP: 1.Anti-Fibrotic Nerandomilast Proves Tolerable Compared With Other IPF/PPF Drugs

EP: 2.ERS Data Could Position Nerandomilast as Anti-Fibrotic of Choice

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EP: 3.Expert Call for Access Reform and Multidisciplinary Care in ILD Management

EP: 4.Multi-Stakeholder Collaboration Is Essential to Achieve Equity in IPF Care

Unlocking access and ensuring comprehensive supportive care are the next frontiers for treating interstitial lung disease (ILD) following the clinical success of new agents like nerandomilast. Steven Nathan, MD, medical director of the advanced lung disease and lung transplant program at Inova Health System at Fairfax Hospital, addressed the vital non-clinical elements of ILD management, extending his commentary on data presented at the European Respiratory Society (ERS) Congress 2025.1,2

Nathan flagged the high cost of anti-fibrotic medications as an ongoing issue, noting that none of these specialized drugs are cheap. This financial hurdle often creates severe access challenges, particularly for patients without adequate insurance or those facing exceedingly high co-payments. Furthermore, access is compounded by the limited availability of specialized care, as many underserved regions lack referral centers or facilities accredited by the Pulmonary Fibrosis Foundation (PFF).

To combat this, Nathan credited pharmaceutical companies, including the developer of nerandomilast, for having "all the elements in place as much as possible" to provide support. These include multiple channels for patient education, financial assistance programs, and direct efforts to ensure access, though he conceded that the problem persists.

Beyond drug access, Nathan emphasized that effectively managing ILD demands a holistic approach that integrates essential ancillary services. He asserted that comprehensive care requires more than just medical therapies and should center around a multidisciplinary team, arguing that while a multidisciplinary discussion is necessary for diagnosis, a dedicated team is integral for ongoing holistic management. This team should ideally be housed in accredited ILD centers.

Key elements of this essential supportive care include:

• Pulmonary Rehabilitation: Crucial for physical conditioning and quality of life
• Supplemental Oxygen Therapy: Necessary for managing disease-related respiratory compromise
• Comorbidity Management: Actively evaluating and treating the multiple co-existing conditions common in patients with ILD
• Specialized Support Roles: Integrating professionals like dietitians (for nutritional needs), pulmonary rehab specialists, social workers, and financial coordinators ensures all aspects of the patient's well-being—clinical, financial, and emotional—are addressed.

Nathan concluded that while pharmaceutical success with nerandomilast is a victory, true patient management requires stakeholders to work collaboratively to dismantle the financial barriers to access and rigorously integrate comprehensive, multidisciplinary supportive care to truly optimize patient outcomes.

References

1. Wijsenbeek MS, Assassi S, Azuma A, et al. Late breaking abstract - effect of nerandomilast on clinical outcomes in patients with progressive pulmonary fibrosis (PPF): results from the final database lock of the FIBRONEER-ILD trial. Presented at ERS Congress 2025; September 27-October 1, 2025; Amsterdam, Netherlands. Poster 1147.
2. Oldham JM, Assassi S, Azuma A, et al. Late breaking abstract - safety and tolerability of nerandomilast in patients with pulmonary fibrosis: pooled data from the FIBRONEER-IPF and FIBRONEER-ILD trials. Presented at ERS Congress 2025; September 27-October 1, 2025; Amsterdam, Netherlands. Poster 2977.