Antifibrotics for COVID-19 related lung fibrosis: Agents with benefits?

ABSTRACT

Coronavirus Disease-2019 (COVID-19), caused by the novel coronavirus, remains a largely unsolved mystery for researchers around the world as its global onslaught upon mankind continues unabated. To make matters worse, an upcoming and alarming trend that is increasingly being noticed as a post-COVID sequel is that of pulmonary fibrosis. Given the scale of the pandemic, the magnitude of this problem is likely to be high. Extrapolated conclusions from previous studies discussing the beneficial role of antifibrotics in progressive fibrosing interstitial lung diseases provide some hope that these medicines might have a potentially useful role in COVID-19 related lung fibrosis as well. Increased serum levels of inflammatory and pro-fibrotic mediators in COVID-19 patients, similar cytokine profiles in idiopathic pulmonary fibrosis and COVID-19, and broad anti-fibrotic activity of approved antifibrotics irrespective of the underlying etiology, are some of the proposed mechanisms favoring the argument. However, no studies currently support or refute the use of antifibrotics in patients developing post-COVID-19 pulmonary fibrosis. In view of such uncertainties, it is critically important for lung fibrosis networks to conduct well-designed prospective clinical trials addressing this issue to find conclusive answers.