We now have a third approved therapy to treat IPF. Adding to pirfenidone (Esbriet) and Nintedanib (OFEV), Nerandomilast (Jascayd) is now available. Based on data that showed less decline in lung function, the new drug was approved in October 2025. Unlike the earlier two medications, Nerandomilast did not show reductions in the rates of hospitalization nor time to first exacerbation.
Dosing
Nerandomilast can be used as stand-alone therapy for IPF or it may be added to existing therapy with either Nintedanib or Pirfenidone. Nerandomilast is available in two strengths—9mg and 18mg. When used as stand-alone therapy or add-on to Nintedanib, either dose may be used. When used as add-on therapy to Pirfenidone, only the 18mg dose is used. Both doses are taken twice daily.
Side Effects
The most common side effect with Nerandomilast is diarrhea. When used as stand-alone therapy or when combined with Pirfenidone, about 25% of patients on the 18mg dose had diarrhea. Diarrhea was seen in 17% of patients on stand-alone therapy with the 9mg dose and 13% when combined with Pirfenidone. When Nerandomilast was combined with Nantadanib, 62% of patients experienced diarrhea. Other than diarrhea, Nerandomilast is well tolerated and no lab monitoring is required.
Where dose Nerandomilast fit into the current treatment paradigm?
For patients who have not tolerated Pirfenidone or Nintedanib, Nerandomilast is the obvious choice. For patients who are getting worse despite either Nintedanib or Pirfenidone, adding Nerandomilast is also a good choice. Patients already struggling with diarrhea are at high risk for not tolerating the addition of Nirendomilast. Patients who have a difficult time with blood draws for lab monitoring, Nerandomilast is a good option.
For newly diagnosed patients with IPF, I still prefer either Nintedanib or Pirfenidone based on the data showing reductions in the rate of first exacerbation and rate of hospitalization. However, perhaps as we gain more experience and see more data, this difference will not be as important.