Antithrombin III as predictive indicator of survival in IPF patients treated with Nintedanib: a preliminary study

INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease often managed with Nintedanib, a tyrosine kinase inhibitor targeting several profibrotic pathways. Although clotting processes are involved in wound healing and repair in the lung, there is no data on the role of antithrombin III on in IPF patients treated with Nintedanib. A previous proteomic analysis of serum of IPF patients before and after one year of Nintedanib treatment showed differential protein expression of antithrombin III. AIMS: Here we used quantitative methods to evaluate differential ATIII concentrations in IPF patients before and after one year of Nintedanib treatment and to assess the potential of ATIII as a prognostic biomarker in IPF patients. METHODS: Serum levels of ATIII were measured by ELISA in 14 IPF patients before and after one year of Nintedanib treatment. RESULTS: A statistically significant inverse correlation was found between serum ATIII concentrations and PFT s parameters in all patients at baseline and follow up. Baseline serum ATIII and BAL neutrophils proved to be reliable predictors of poor prognosis. A baseline ATIII threshold of 126.5 mug/mL discriminated survivors from non-survivors. CONCLUSIONS: After 12 months of antifibrotic treatment, IPF patients with high serum ATIII concentrations and high BAL neutrophil percentages had a poor prognosis and increased survival risk. The results of this preliminary study suggest, that ATIII has potential as a biomarker of IPF severity and in predicting answer to Nintedanib therapy. As a marker, ATIII showed several advantages over BAL neutrophil percentage. This article is protected by copyright. All rights reserved.