CTD-ILD pipeline heats up as physicians seek disease modification
Connective tissue disease-associated interstitial lung disease remains a condition where current treatments fall well short of what physicians want, despite a wave of new entrants to the market. A survey of 54 rheumatologists and 53 pulmonologists conducted by Spherix Global Insights in March 2026 found that physicians estimate only 15% of CTD-ILD patients achieve drug-free remission, and most respondents expressed dissatisfaction with available options. The findings form part of the firm's updated Special Topix: ILD in Rheumatology (US) study, published this week.
The treatment landscape continues to lean on established agents including mycophenolate mofetil, corticosteroids, rituximab, tocilizumab, and antifibrotic therapies. Physicians surveyed identified improved efficacy, fibrosis reversal, better tolerability, and disease-specific approaches as the most pressing unmet needs, a set of demands that no currently approved therapy fully addresses.
Jascayd makes early gains over nintedanib
The most consequential recent development, according to the survey, is the approval and launch of Boehringer Ingelheim's nerandomilast, marketed as Jascayd. The drug was approved for idiopathic pulmonary fibrosis and progressive pulmonary fibrosis, including patients with progressive fibrosing CTD-ILD. Physicians already view Jascayd favourably against the incumbent antifibrotic nintedanib (Boehringer's own OFEV) on gastrointestinal tolerability and overall tolerability. That competitive edge matters in a chronic disease where long-term adherence is closely tied to side-effect burden. The antifibrotic market is also being reshaped by the 2026 entry of multiple generic nintedanib products, which will pressure branded revenues and could accelerate physician willingness to trial newer agents.
Boehringer is pursuing further expansion in rheumatology-associated ILD populations, with dedicated studies under way in systemic autoimmune rheumatic disease-associated ILD and systemic sclerosis-associated ILD, signalling that the company regards CTD-ILD as a strategically distinct and commercially important category.
CAR-T and next-generation mechanisms draw specialist interest
Beyond the antifibrotic class, physician enthusiasm is coalescing around a more ambitious therapeutic goal: disease modification rather than stabilisation. Among rheumatologists, Bristol Myers Squibb's investigational CD19-directed CAR-T candidate zola-cel attracted notable interest, cited for its potential to deliver a durable immune reset and for early signals suggesting possible fibrosis reversal in systemic sclerosis-associated ILD. GSK's belimumab (Benlysta), well established in systemic lupus erythematosus, also generated enthusiasm among rheumatologists already familiar with its mechanism.
Pulmonologists expressed stronger interest in agents closer to existing ILD paradigms. United Therapeutics' nebulised treprostinil (Tyvaso) ranked highly among pulmonologists with a background in pulmonary hypertension-associated ILD, while oral lysophosphatidic acid receptor 1 antagonists were cited as a promising next-generation antifibrotic mechanism.
Ryan Rex, Senior Director at Spherix Global Insights, noted that the survey reflects a pivotal shift in clinical expectations. "What stands out is the growing enthusiasm for therapies that may fundamentally alter disease course, whether through next-generation antifibrotic approaches, increasingly disease-specific treatment strategies, or highly targeted immune interventions such as CAR-T cell therapy," he said. "It is one of the most active CTD-ILD pipelines we've seen in years."
The divergence in priorities between rheumatologists and pulmonologists is itself a market dynamic worth watching. CTD-ILD sits at the intersection of two specialties with different treatment traditions, and commercial success for pipeline assets will likely depend on building cross-specialty credibility. That cross-disciplinary complexity has historically slowed uptake of novel agents in the indication, adding a layer of launch risk for companies advancing candidates through late-stage development.
The Spherix findings are based on a commercial market research study rather than a peer-reviewed clinical dataset, and the survey sample of 107 physicians, while representative of specialist opinion, is modest in scale. Nonetheless, the data offer a useful early read on how key opinion leaders are likely to position emerging therapies once they approach the market.