Steven D. Nathan, MD

Achieving equitable access to anti-fibrotic drugs requires multi-stakeholder collaboration, while the most critical unmet clinical need remains overcoming late and misdiagnosis through targeted education to ensure earlier therapy and better patient outcomes.

Following the clinical success of new agents like nerandomilast, the next critical steps for managing ILD involve dismantling financial and geographical barriers to access, and rigorously integrating comprehensive, multidisciplinary supportive care including pulmonary rehabilitation and comorbidity management.

Nerandomilast's tolerability and dual antifibrotic/immunomodulatory mechanism directly address the critical non-adherence issue with current therapies, positioning it as a potential first-line treatment for IPF and PPF despite remaining questions about very long-term efficacy and the need for biomarkers.

Nerandomilast, a novel anti-fibrotic agent with improved tolerability and a dual antifibrotic/immunomodulatory mechanism, showed sustained efficacy in the FIBRONEER trials for IPF and PPF, achieving FDA approval for IPF in October 2025.

Steven Nathan, MD, discusses additional noteworthy data from CHEST 2024 on emerging therapies for IPF and PAH and highlights his excitement for ongoing research focused on improving early detection, personalized treatments, and improving long-term patient outcomes.

Steven Nathan, MD, discusses how the study on inhaled treprostinil for CTD-PAH demonstrates its comparable efficacy to intravenous and subcutaneous forms, with a better safety profile, which could lead to improved patient adherence and management of CTD-PAH.

Steven Nathan, MD, discusses how the findings from the study on oral nalbuphine extended release suggest that this treatment may offer an effective option for managing IPF-related cough, providing significant relief in terms of both frequency and severity, which could shift current management strategies by introducing a more targeted, pharmacologic approach to addressing one of the most challenging symptoms of IPF.

Steven Nathan, MD, discusses the abstract “Analysis of Relief-of-Cough in Patients With Idiopathic Pulmonary Fibrosis Treated With Oral Nalbuphine Extended Release,” which aimed to assess the effectiveness of oral nalbuphine extended release in providing relief from chronic cough in patients with IPF; the study used a clinical trial design to evaluate cough severity, with results showing that nalbuphine significantly reduced cough frequency and intensity, offering a potential new treatment option for managing this common and debilitating symptom of IPF.

Steven Nathan, MD, discusses how the data from the IPF-PRO Registry highlights the critical relationship between early diagnosis and prognosis in IPF, revealing that FVC percent predicted, oxygen use, BMI, and age are key indicators of long-term survival, underscoring the importance of early identification, and personalized treatment plans to improve patient outcomes.

Steven Nathan, MD, discusses the abstract “Predicting Long-Term Survival in Patients With Idiopathic Pulmonary Fibrosis: Data From the IPF-PRO Registry,” which aimed to identify key predictors of long-term survival in IPF using data from the IPF-PRO Registry; the study employed a classification and regression tree model to analyze variables such as FVC percent predicted, oxygen use, BMI, and age, and found that factors such as oxygen use and FVC levels were strong predictors of survival beyond 5 years.

Coming into CHEST 2024, Steven Nathan, MD, discusses how the largest unmet needs in the treatment and management of IPF and PAH include improving early diagnosis, addressing symptom management (particularly chronic cough), and developing more effective, accessible therapies to enhance long-term patient outcomes.

Dr Nathan provides his final thoughts regarding IPF management.

Dr Nathan discusses the trajectory of IPF management.

Steven Nathan, MD, continues a discussion surrounding the patient journey in through IPF treatment.

Dr Nathan highlights the role of PDE4B inhibitors in IPF management.

Steven Nathan, MD, discusses breakthrough treatments for idiopathic pulmonary fibrosis.