Antifibrotics increase survival probability in COVID-19, acute respiratory failure

Key takeaways:

• Patients receiving antifibrotics vs. control patients had a significantly lower risk for 1-year mortality.
• The nintedanib group had significantly higher survival probability than the control group.

Among patients with COVID-19 and acute respiratory failure, survival at 1 year was more likely if they received nintedanib or pirfenidone antifibrotics, according to results published in BMC Pulmonary Medicine.

“This study offers important insights into the therapeutic potential of these agents in managing the complex pathogenesis of both COVID-19-induced pulmonary fibrosis and idiopathic pulmonary fibrosis,” Hsin-Yi Wang, MD, PhD, of the department of nuclear medicine at Taichung Veterans General Hospital, and colleagues wrote. “The findings underscore the significance of targeting fibroproliferative pathways and the [renin-angiotensin system] in mitigating inflammation and fibrosis.”

In a retrospective, multi-institutional cohort study, Wang and colleagues assessed adults with COVID-19 and acute respiratory failure to compare differences in 1-year mortality among 167 patients (mean age, 64.5 years; 59.3% men; 75.4% white) who received either nintedanib (Ofev, Boehringer Ingelheim; n = 127) or pirfenidone (n = 39) vs. 167 propensity score-matched control patients (mean age, 65.8 years; 59.3% men; 64.1% white).

Propensity score matching factored in age, gender, comorbidities and corticosteroid use, according to researchers.

Between the two sets of patients, those who received antifibrotics had a higher survival probability than the control patients (84.42% vs. 69.87%).

Following suit, researchers found that patients in the antifibrotic group vs. the control group had a significant decreased risk for 1-year mortality (HR = 0.434; 95% CI, 0.264-0.712).

When divided by antifibrotic agent, patients receiving nintedanib vs. control patients had significantly higher 1-year survival probability (P = .013), but improvement in this outcome was not significant when comparing those receiving pirfenidone vs. control patients, according to researchers.

Researchers also spilt up the total cohort according to strain time frames (Wuhan, alpha, delta and omicron). In each time frame, 1-year survival probability was higher among patients receiving an antifibrotic vs. control patients, but the Wuhan strain period specifically showed significantly better survival probability (P = .002).

“Further research and clinical trials are needed to confirm the efficacy of these antifibrotic agents in the context of COVID-19 and acute respiratory failure,” Wang and colleagues wrote.