Pneumology - Original Articles
June 11, 2025

Impact of antifibrotics on post-COVID-19 lung sequelae

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Respiratory problems in acute COVID-19 and post-acute COVID-19 syndrome vary greatly, potentially leading to long-term functional difficulties. Off-label usage of antifibrotics, such as pirfenidone, has emerged as a promising treatment for post-COVID interstitial lung problems. Our study aims to assess clinical and radiological lung abnormalities post-COVID-19 and the effect of antifibrotics on the outcome. A retrospective observational study examined data from 90 COVID-19 patients who completed the follow-up period in the post-COVID clinic at the Chest Department, Kasr El Ainy Hospital, from August 2020 to August 2022. Demographic data, comorbidities, exercise tolerance, and chest computed tomography (CT) results were collected 1 and 6 months after the diagnosis. Initial CT scans (1 month following hospital admission) revealed diffuse ground-glass opacities (87.8%) and reticulations (43.3%). After 6 months, 33.3% were back to normal, 41% had persistent reticulations, 22.2% had ground glass opacities, and 3.3% had bronchiectasis. CT scores improved dramatically after 6 months. No significant link was detected between CT score change and off-label use of pirfenidone. Antifibrotic therapy has a modest effect on post-COVID lung problems. One-third of patients showed reticulations as persistent radiological abnormalities, which could guide future treatment choices.

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Jasper FW, Shuofeng Y, Kin-Hang K, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020;395:514-23. DOI: https://doi.org/10.1016/S0140-6736(20)30154-9
Alimohamadi Y, Sepandi M, Taghdir M, Hosamirudsari H. Determine the most common clinical symptoms in COVID-19 patients: a systematic review and meta-analysis. J Prev Med Hyg 2020;61:304-12. DOI: https://doi.org/10.18502/ijph.v49i7.3574
Barboza J, Chambergo-Michilot D, Velasquez-Sotomayor M, et al. Assessment and management of asymptomatic COVID-19 infection: a systematic review. Travel Med Infect Dis 2021;41:102058.‏ DOI: https://doi.org/10.1016/j.tmaid.2021.102058
Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021;397:220-32. Expression of concern: Lancet 2023;401:90. Retracted and republished in: Lancet 2023;401:e21-33. DOI: https://doi.org/10.1016/S0140-6736(22)02370-4
Walls A, Park Y, Tortorici M, et al. Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein. Cell 2020;181:281-92.‏ DOI: https://doi.org/10.1016/j.cell.2020.02.058
Frontera J, Thorpe L, Simon N, et al. Post-acute sequelae of COVID-19 symptom phenotypes and therapeutic strategies: a prospective, observational study. Plos One 2022;17:e0275274.‏ DOI: https://doi.org/10.1371/journal.pone.0275274
Mylvaganam R, Bailey J, Sznajder J, Sala M. Recovering from a pandemic: pulmonary fibrosis after SARS-CoV-2 infection. Eur Respir Rev 2021;30:210194.‏ DOI: https://doi.org/10.1183/16000617.0194-2021
Lechowicz K, Drożdżal S, Machaj F, et al. COVID-19: the potential treatment of pulmonary fibrosis associated with SARS-CoV-2 infection. J Clin Med 2022;9:1917.‏ DOI: https://doi.org/10.3390/jcm9061917
Zeng Z, Huang X, Lu P, et al. Imaging manifestations and pathological analysis of severe pneumonia caused by human infected avian influenza (H7N9). Radiol Infect Dis2015;1:64-9.‏ DOI: https://doi.org/10.1016/j.jrid.2015.02.003
Dhooria S, Maturu VN, Talwar D, et al. A multicenter survey study of anti-fibrotic use for symptomatic patients with post-COVID-19 interstitial lung abnormalities. Lung India 2022;39:254-60.‏ DOI: https://doi.org/10.4103/lungindia.lungindia_568_21
Masoud H, Elassal G, Hassany M, et al. Management protocol for COVID-19 patients version 1.4/30th May 2020. In: Coronavirus Disease 2019 (COVID-19), SARS COV2 Management Guideline. Egypt: Ministry of health and population (MOHP); 2020.
Li K, Fang Y, Li W, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). Eur Radiol 2022;30:4407-16. DOI: https://doi.org/10.1007/s00330-020-06817-6
Twitchell D, Christensen M, Hackett G, et al. Examining male predominance of severe COVID-19 outcomes: a systematic review. Androg Clin Res Ther 2022;3:41-53.‏ DOI: https://doi.org/10.1089/andro.2022.0006
Vijayakumar B, Tonkin J, Devaraj A, et al. CT lung abnormalities after COVID-19 at 3 months and 1 year after hospital discharge. Radiology 2022;30:444-54. DOI: https://doi.org/10.1148/radiol.2021211746
Jia F, Wang G, Xu J, et al. Role of tumor necrosis factor-α in the mortality of hospitalized patients with severe and critical COVID-19 pneumonia. Aging 2022;13:23895-912. DOI: https://doi.org/10.18632/aging.203663
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2022;395:1054-62.‏ DOI: https://doi.org/10.1016/S0140-6736(20)30566-3
Guo W, Li M, Dong Y, et al. Diabetes is a risk factor for the progression and prognosis of COVID‐19. Diabetes Metab Res Rev 2022;36:e3319.‏ DOI: https://doi.org/10.1002/dmrr.3319
Ma R, Holt R. COVID‐19 and diabetes. Diabetic Med 2020;37:723-5.‏ DOI: https://doi.org/10.1111/dme.14300
Magdy S, Elkorashy R, Elsebaie E, et al. Impact of comorbid pulmonary disease on COVID-19 disease severity and outcome: a retrospective cohort study. Egypt J Bronchol 2023;17:64.‏ DOI: https://doi.org/10.1186/s43168-023-00240-3
Mardani R, Namavar M, Ghorbi E, et al. Association between serum inflammatory parameters and the disease severity in COVID‐19 patients. J Clin Lab Anal 2022;36:e24162. DOI: https://doi.org/10.1002/jcla.24162
Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respira Med 2020;8:e21.‏ DOI: https://doi.org/10.1016/S2213-2600(20)30116-8
Núñez-Fernández M, Ramos-Hernández C, García-Río F, et al. Evolution and long‑term respiratory sequelae after severe COVID-19 pneumonia: nitric oxide diffusion measurement value. Respir Res 2023;24:48. DOI: https://doi.org/10.1186/s12931-023-02344-2
Rees EM, Nightingale ES, Jafari Y, et al. COVID-19 length of hospital stay: a systematic review and data synthesis. BMC Med 2020;18:270. DOI: https://doi.org/10.1186/s12916-020-01726-3
Seifirad S. Pirfenidone: a novel hypothetical treatment for COVID-19. Med Hypotheses 2020;144:110005. DOI: https://doi.org/10.1016/j.mehy.2020.110005
Vasarmidi E, Tsitoura E, Spandidos DA, et al. Pulmonary fibrosis in the aftermath of the COVID-19 era (Review). Exp Ther Med 2020;20:2557-60. DOI: https://doi.org/10.3892/etm.2020.8980
Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020;180:934-43. DOI: https://doi.org/10.1001/jamainternmed.2020.0994
Rivera-Ortega P, Hayton C, Blaikley J, et al. Nintedanib in the management of idiopathic pulmonary fibrosis: clinical trial evidence and real-world experience. Ther Adv Respir Dis 2018;12:1753466618800618. DOI: https://doi.org/10.1177/1753466618800618
Daher A, Balfanz P, Cornelissen C, et al. Follow up of patients with severe coronavirus disease 2019 (COVID-19): pulmonary and extrapulmonary disease sequelae. Respir Med 2020;174:106197. DOI: https://doi.org/10.1016/j.rmed.2020.106197
Van den Borst B, Peters J, Brink M, et al. Comprehensive health assessment 3 months after recovery from acute coronavirus disease 2019 (COVID-19). Clin Infect Dis 2021;73:e1089-98. DOI: https://doi.org/10.1093/cid/ciaa1750
Lomanta JMJ, Quinto ML, Urquiza SC, Santiaguel JM. Pulmonary function and chest computed tomography (CT) scan findings after antifibrotic treatment for COVID-19-related pulmonary fibrosis. Am J Case Rep 2022;23:e934830. DOI: https://doi.org/10.12659/AJCR.934830
Marwah V, Choudhary R, Malik V, et al. Early experience of nintedanib in COVID-19 ARDS-related pulmonary fibrosis: a case series. Adv Respir Med 2021;89:589-96. DOI: https://doi.org/10.5603/ARM.a2021.0113
Zhou X, Yang D, Kong X, et al. Case report: pirfenidone in the treatment of post-COVID-19 pulmonary fibrosis. Front Med 2022;9:925703.‏ DOI: https://doi.org/10.3389/fmed.2022.925703
Zhang F, Wei Y, He L, et al. A trial of pirfenidone in hospitalized adult patients with severe coronavirus disease 2019.Chin Med J 2022;135:368-70. DOI: https://doi.org/10.1097/CM9.0000000000001614
Ferrara F, La Porta R, Santilli P, et al. Are multiple sclerosis therapies safe in severe acute respiratory syndrome coronavirus 2 times? Indian J Pharmacol 2020;52:441-2. DOI: https://doi.org/10.4103/ijp.IJP_417_20
Kayarat B, Khanna P& Sarkar S. Pulmonary fibrosis in COVID-19 recovered patients: problem and potential management. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine 2021;25: 242. DOI: https://doi.org/10.5005/jp-journals-10071-23733
Wang HY, Tsai SC, Lin YC, et al. The effect of anti-fibrotic agents on acute respiratory failure in COVID-19 patients: a retrospective cohort study from TriNetX US collaborative networks. BMC Pulm Med 2024;24:160. DOI: https://doi.org/10.1186/s12890-024-02947-5
Lassan S, Tesar T, Tisonova J, Lassanova M. Pharmacological approaches to pulmonary fibrosis following COVID-19. Front Pharmacol 2023;14:1143158. DOI: https://doi.org/10.3389/fphar.2023.1143158

Ethics Approval

Ethical committee approval was obtained from the research ethics committee of Cairo University, with IRB number MD-5-2022.

How to Cite



“Impact of Antifibrotics on Post-COVID-19 Lung Sequelae”. 2025. Monaldi Archives for Chest Disease, June. https://doi.org/10.4081/monaldi.2025.3301.