Mariano E. Mazzei

Nintedanib in the treatment of idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is a progressive and ultimately fatal lung disease that occurs in older adults. The clinical course of IPF is variable and hard to predict in an individual patient. Nintedanib is a tyrosine kinase inhibitor that has recently been approved in the US and European Union for the treatment of IPF. Preclinical studies have shown that nintedanib interferes with processes active in fibrosis such as fibroblast proliferation, migration and differentiation and the secretion of extracellular matrix. The safety and efficacy of nintedanib have been investigated in the phase II TOMORROW trial and in two replicate 52-week randomized, placebo-controlled phase III trials known as the INPULSIS trials. These trials demonstrated that nintedanib slowed disease progression by reducing the annual rate of decline in forced vital capacity, with a manageable side-effect profile. In this review, we summarize key data supporting nintedanib as a treatment for patients with IPF and address key questions regarding the use of nintedanib in the clinical setting.

Bilateral diaphragmatic paralysis in an HIV patient: Second reported case and literature review

Human immunodeficiency virus (HIV) disease is widespread all over the world, and the neurological and respiratory complications have been described previously. Peripheral neuropathy is one of the commonest neurological complications of the HIV infection. In this report we describe a HIV positive male smoker who was admitted to the hospital because of community acquired pneumonia. Bilateral diaphragmatic paralysis was diagnosed for which no other cause was found and was attributed to the HIV infection. Isolated phrenic neuropathy and diaphragmatic paralysis in an HIV positive patient is extremely rare and only a single such association has been described previously.