Multi-Stakeholder Collaboration Is Essential to Achieve Equity in IPF Care

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

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

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

The emergence of nerandomilast, a new anti-fibrotic agent, represents a potential paradigm shift in the management of idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF). Steven Nathan, MD, medical director of the advanced lung disease and lung transplant program at Inova Health System at Fairfax Hospital in Falls Church, Virginia, commented on data presented at the European Respiratory Society (ERS) Congress 2025, highlighting the drug’s novel mechanism and superior tolerability profile—key advantages over the current standard-of-care therapies.1,2

Nathan identified that achieving equity of access to anti-fibrotic drugs requires a comprehensive, multi-stakeholder collaboration. He asserted that solutions must come from various groups working together, a model already successfully employed in the design of clinical trials. The essential stakeholders in this effort include clinicians at specialized ILD centers, advocacy groups like the Pulmonary Fibrosis Foundation (PFF) and the Pulmonary Hypertension Association (PHA), pharmaceutical companies, and even the FDA. Crucially, Nathan stressed that patients themselves are key elements who must be included in defining the best course of care, especially concerning access issues like high co-payments and geographical barriers to specialized centers.

Despite the optimism surrounding the approval of a third IPF therapy, Nathan emphasized that significant unmet needs persist. He stressed that none of the approved drugs are a "panacea" or a cure. The most immediate gap he cited is the frequent problem of late diagnosis and misdiagnosis. Because the primary symptom of IPF (shortness of breath) is shared with much more common conditions like chronic obstructive pulmonary disease (COPD), asthma, and congestive heart failure, patients are often misdiagnosed. To address this, Nathan called for ongoing education for both pulmonologists and primary care providers, as earlier diagnosis leads directly to earlier therapy and better outcomes.

Looking to the future, Nathan expressed optimism, citing the numerous molecules in various stages of development—including the positive TETON-2 study and the anticipated TETON-1 results for drugs like inhaled treprostinil, which could soon offer a potential fourth therapeutic option. However, he maintained that even with four drugs, there will still be "room for improvement" in the pharmacological approach. The field must prioritize continued research into finding a definitive treatment and improving health care system processes to tackle the critical issue of diagnostic delays

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.