Idiopathic pulmonary fibrosis (IPF) gained its first new drug in a decade in 2025. Nerandomilast (Jascayd), a first-in-class oral preferential PDE4B inhibitor, slowed the decline in forced vital capacity versus placebo in the Phase 3 FIBRONEER-IPF trial — whether or not patients were also taking an existing antifibrotic — and was FDA-approved in October 2025 (with a parallel program in progressive pulmonary fibrosis). Its main side effect is mild diarrhea, and it appears better tolerated than older nonselective PDE4 inhibitors.
The established antifibrotics pirfenidone and nintedanib remain foundational, each slowing the rate of lung-function decline by roughly half without halting progression, at the cost of gastrointestinal and hepatic side effects. It is worth noting the failures that shaped this landscape: pamrevlumab (anti-connective-tissue growth factor) looked promising in Phase 2 but did not separate from placebo in its Phase 3 ZEPHYRUS trial, and zinpentraxin alfa failed its Phase 3 STARSCAPE trial — reminders of how hard IPF has been to treat and why nerandomilast's success matters.
Further reading: FIBRONEER-IPF nerandomilast (Richeldi et al., NEJM 2025) and FDA approval (2025); pirfenidone (King et al., NEJM 2014) and nintedanib (Richeldi et al., NEJM 2014); ZEPHYRUS-1 pamrevlumab (Raghu et al., JAMA 2024, negative).