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Systemic Sclerosis — SCE Rheumatology MCQ

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ModerateSystemic SclerosisSystemic SclerosisSCE Rheumatology

A 62-year-old woman has systemic sclerosis-associated interstitial lung disease (SSc-ILD). Despite appropriate disease-modifying treatment, serial assessment shows worsening fibrotic ILD with a 12% relative fall in FVC over 12 months and increased fibrosis on HRCT. Nintedanib is being considered. Which option correctly identifies its class and principal role in SSc-ILD?

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Correct answer: C — Tyrosine kinase inhibitor with antifibrotic activity; used to slow FVC decline in SSc-ILD

Nintedanib is a small-molecule tyrosine kinase inhibitor with antifibrotic activity, including inhibition of PDGFR, FGFR and VEGFR signalling. In SSc-ILD, its key demonstrated benefit is slowing the rate of FVC decline rather than reversing established fibrosis or treating systemic sclerosis skin disease. It is licensed in UK adults with SSc-ILD. SENSCIS showed a lower annual FVC decline with nintedanib than placebo, with comparable treatment effects in patients with and without background mycophenolate. Therefore, it should not be described as obligatorily add-on to immunosuppression in every case. It is not a biologic DMARD. PDE5 inhibitors are used for SSc-associated PAH and digital vasculopathy, while calcineurin inhibitors do not prevent scleroderma renal crisis.

Reference: Electronic Medicines Compendium. Nintedanib 150 mg Soft Capsules: Summary of Product Characteristics, sections 4.1 and 5.1, updated 14 July 2026. https://www.medicines.org.uk/emc/product/102444/smpc