Ramosetron as a Supportive Agent to Continue Nintedanib in Patients with Interstitial Lung Disease

Abstract

Objective Although nintedanib is commonly used to treat interstitial lung disease (ILD), its clinical utility is often limited by adverse gastrointestinal events. Ramosetron, a selective 5-HT₃ receptor antagonist, has shown efficacy in managing irritable bowel syndrome; however, its effects on nintedanib-associated abdominal symptoms remain unclear. This study evaluated the effect of ramosetron on continuation of nintedanib therapy.

Patients and Methods This retrospective analysis enrolled patients with ILD who received nintedanib at our institute between August 2018 and October 2024, and the clinical courses of those receiving nintedanib with or without ramosetron were compared. The duration of nintedanib administration was evaluated using the log-rank test, and a multivariate Cox proportional hazards regression analysis was performed to identify the factors associated with the duration of nintedanib treatment.

Results Among the 142 patients included in the analysis, 55 were administered ramosetron and 87 were not. The duration of nintedanib therapy was significantly longer in the ramosetron group than in the non-ramosetron group (1,269 vs. 497 days; p=0.005). Ramosetron administration was an independent factor associated with prolonged nintedanib treatment even after adjusting for clinical variables. Notably, ramosetron treatment initiated after nintedanib therapy was more effective than its prophylactic use.

Conclusion Ramosetron administration significantly correlated with prolonged duration of nintedanib therapy. The selective use of ramosetron may improve adherence to nintedanib treatment. However, prospective studies are required to validate these findings.