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Published on: June 20, 2025
Pulmonary fibrosis and COVID-19: the potential role for antifibrotic therapy
Peter M George1, Athol U Wells1, R Gisli Jenkins2
1Royal Brompton and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
Insights
Antifibrotic therapies may help manage severe COVID-19 and prevent lung fibrosis. Research explores their role in idiopathic pulmonary fibrosis (IPF) patients and general populations during the SARS-CoV-2 pandemic.
Area of Science:
- Pulmonology
- Infectious Diseases
- Pharmacology
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19, a disease with diverse symptoms and significant mortality.
- Idiopathic pulmonary fibrosis (IPF) shares risk factors with severe COVID-19, including age, male sex, hypertension, and diabetes.
- The impact of antifibrotic therapy on IPF patients with COVID-19 is unclear, necessitating investigation into its role.
Purpose of the Study:
- To explore the potential benefits of antifibrotic therapies in managing COVID-19.
- To investigate the role of antifibrotic agents in IPF patients infected with SARS-CoV-2.
- To assess the value of antifibrotic treatments in preventing or treating lung fibrosis post-COVID-19.
Main Methods:
- Review of existing data on antifibrotic compounds in acute lung injury and viral pneumonia models.
- Analysis of outcomes from previous coronavirus infections (SARS, MERS) and emerging COVID-19 data.
- Evaluation of the scientific rationale for continuing or ceasing antifibrotic therapy in IPF patients with COVID-19.
Main Results:
- Previous coronavirus infections suggest potential for significant fibrotic lung consequences.
- Antifibrotic therapies have been evaluated in preclinical models relevant to COVID-19.
- Emerging data indicates a potential role for antifibrotic agents in COVID-19 management.
Conclusions:
- Antifibrotic therapies may prevent severe COVID-19 in IPF patients.
- These therapies show potential for treating severe COVID-19 in non-IPF patients.
- Antifibrotic agents might be crucial in mitigating long-term lung fibrosis after SARS-CoV-2 infection.
Abstract:
In December, 2019, reports emerged from Wuhan, China, of a severe acute respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). By the end of April, 2020, over 3 million people had been confirmed infected, with over 1 million in the USA alone, and over 215 000 deaths. The symptoms associated with COVID-19 are diverse, ranging from mild upper respiratory tract symptoms to severe acute respiratory distress syndrome. The major risk factors for severe COVID-19 are shared with idiopathic pulmonary fibrosis (IPF), namely increasing age, male sex, and comorbidities such as hypertension and diabetes. However, the role of antifibrotic therapy in patients with IPF who contract SARS-CoV-2 infection, and the scientific rationale for their continuation or cessation, is poorly defined. Furthermore, several licensed and potential antifibrotic compounds have been assessed in models of acute lung injury and viral pneumonia. Data from previous coronavirus infections such as severe acute respiratory syndrome and Middle East respiratory syndrome, as well as emerging data from the COVID-19 pandemic, suggest there could be substantial fibrotic consequences following SARS-CoV-2 infection. Antifibrotic therapies that are available or in development could have value in preventing severe COVID-19 in patients with IPF, have the potential to treat severe COVID-19 in patients without IPF, and might have a role in preventing fibrosis after SARS-CoV-2 infection.
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