Therapeutic effects of nintedanib are not influenced by emphysema in the INPULSIS trials.

Emphysema is a common comorbidity in patients with idiopathic pulmonary fibrosis (IPF) [1–4]. Due to the combination of restrictive and obstructive effects, patients with concomitant IPF and emphysema typically present with normal or elevated forced vital capacity (FVC) but reduced diffusing capacity [5]. Data from retrospective studies have demonstrated that lung function decline is attenuated in patients with IPF who have emphysema [6], with some evidence suggesting a threshold for extent of emphysema beyond which FVC decline is reduced [7].Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Azuma reports personal fees from Boehringer Ingelheim, during the conduct of the study; grants and other from Boehringer Ingelheim, outside the submitted work.Conflict of interest: Dr. Raghu reports other from BI, during the conduct of the study; grants from NIH, other from Bellerophan, other from Biogen, other from BMS, other from Fibrogen, other from Gilead, other from Nitto, other from Patara, other from Promedior, other from Sanofi, other from Veracyte, outside the submitted work.Conflict of interest: Dr. Stansen has nothing to disclose.Conflict of interest: Dr. Kolb reports grants and other from Boehringer Ingelheim, during the conduct of the study; grants and personal fees from Roche, grants and personal fees from Boehringer Ingelheim, grants and personal fees from GSK, personal fees from Gilead, grants from Actelion, grants from Respivert, personal fees from Genoa, grants from Alkermes, grants from Pharmaxis, grants and personal fees from Prometic, personal fees from Indalo, personal fees from Third Pole, outside the submitted work.Conflict of interest: Dr. Susanne Stowasser is an employee of Boehringer Ingelheim International GmbH, the marketing authorisation holder of Ofev (nintedanib).Conflict of interest: Rozsa Schlenker Herceg is an employee of Boehringer IngelheimConflict of interest: Dr. Cottin reports personal fees and non-financial support from Actelion, grants, personal fees and non-financial support from Boehringer Ingelheim, personal fees from Bayer / MSD, personal fees from Gilead, personal fees from GSK, personal fees from Novartis, grants, personal fees and non-financial support from Roche, grants from Sanofi, personal fees from Promedior, personal fees from Celgene, personal fees from Galapagos, outside the submitted work.