Impact of anti-fibrotic medications on post-COVID-19 pulmonary fibrosis: A systematic review and meta-analysis.

ABSTRACT

OBJECTIVES: The impact of anti-fibrotic medications on pulmonary fibrosis caused by COVID-19 remains inconclusive and lacks systematic investigation. This study assessed the efficacy of anti-fibrotic drugs in addressing post-COVID-19 lung fibrosis. METHODS: We searched PubMed, Web of Science, Embase, and the Cochrane Library until June 15, 2024. The meta-analysis was performed using Review Manager. Heterogeneity was evaluated utilizing I2 statistic, and publication bias was assessed via funnel plots. RESULTS: The study (CRD42024552847) included 7 trials with 496 participants. No significant differences were observed in chest CT score (SMD = -0.60, 95% CI -1.33 to 0.12, P = 0.10), length of hospital stay (MD = -1.34, 95% CI -4.39 to 1.70, P = 0.39), and mortality (OR = 0.91, 95% CI 0.50 to 1.64, P = 0.75) between anti-fibrosis and standard treatment groups. Notable improvements in pulmonary function were observed with anti-fibrotic drugs, as indicated by FEV1%pred (MD = 23.95, 95% CI 12.24 to 35.67, P < 0.0001) and FEV1/FVC (MD = 18.17, 95% CI 11.96 to 24.38, P < 0.00001). CONCLUSIONS: Anti-fibrotic medications may help reduce fibrotic lesions and improve pulmonary function in post-COVID-19 pulmonary fibrosis, but their practical use is currently based more on theory than on solid medical evidence. Currently, in clinical practice, the use of anti-fibrotic drugs in these patients primarily relies on empirical treatment. Further clinical studies are imperative to bolster its credibility for future applications.