The Effect of Nintedanib in Post-COVID-19 Lung Fibrosis: An Observational Study

Background. Lung fibrosis is a sequela of COVID-19 among patients with severe pneumonia. Idiopathic pulmonary fibrosis and lung fibrosis due to COVID-19 may share many similar features. There are limited data on effects of antifibrotic treatment of infection-related lung fibrosis. This study aimed to evaluate the effect of nintedanib on patients' post-COVID-19 lung fibrosis. Methods. A retrospective, matched case-control study was performed on hospitalized patients with COVID-19 pneumonia. Patients who received nintedanib treatment for COVID-19 pulmonary fibrosis (nintedanib group) were compared to patients with standard treatment (control group). The primary outcome was oxygen improvement. The secondary outcomes were chest X-ray improvement, SpO(2)/FiO(2) ratio improvement, mortality rates at 60 days, and adverse events. Results. A total of 42 patients with COVID-19 pneumonia were included (21 in each group). Mean age was 64.43 +/- 14.59 years, and 54.8% were men. At baseline, SpO(2)/FiO(2) ratio before treatment was 200.57 +/- 105.77 in the nintedanib group and 326.90 +/- 137.10 in the control group (P=0.002). Oxygen improvement and chest X-ray improvement were found in 71.4% and 71.4% in the nintedanib group and in 66.7% and 66.7% in the control group (P=0.739). The nintedanib group had more improvement in SpO(2)/FiO(2) ratio than in the control group (144.38 +/- 118.05 vs 55.67 +/- 75.09, P=0.006). The 60-day mortality rates of the nintedanib and the control groups were 38.1% vs 23.8%, P=0.317. Hepatitis and loss of appetite were common adverse events (9.5% and 9.5%), while the incidence of diarrhea was 4.8%. Conclusions. Nintedanib as add-on treatment in post-COVID-19 lung fibrosis did not improve oxygenation, chest X-ray findings, or the 60-day mortality. However, this antifibrotic drug improved SpO(2)/FiO(2) ratio in our patients. Further randomized controlled trials are needed to determine the efficacy of nintedanib for treatment of patients with post-COVID-19 lung fibrosis. Trial Registration.

Automated summary

This study aimed to evaluate the effect of nintedanib on patients' post-COVID-19 lung fibrosis. The results showed that nintedanib did not improve oxygenation, chest X-ray findings, or the 60-day mortality. However, it did improve the SpO(2)/FiO(2) ratio in the patients. Further randomized controlled trials are needed to determine the efficacy of nintedanib for treatment of patients with post-COVID-19 lung fibrosis.