Assessment of therapeutic benefit obtained on administering nintedanib with respect to pulmonary function parameters in COVID-induced pulmonary fibrosis – A prospective study

Abstract

Background: The COVID-19 infection has not only affected the patients in the acute phase but also has left several long-term sequels which are becoming clinically evident in the long run. The development of pulmonary fibrosis following recovery from COVID-19 is presently a cause of concern worldwide. Fibrosis of the lungs is a long-term ongoing inflammatory disorder which causes functional impairment and chronic pulmonary insufficiency. It is observed that the profibrotic mechanisms responsible for causing post-COVID lung fibrosis have some resemblance with that of autoimmune interstitial lung disease (ILD). Nintedanib, a tyrosine kinase inhibitor, is reported to block the profibrotic cytokine receptors. It is thus being administered widely for disease modification in idiopathic pulmonary fibrosis, a progressive and fatal form of ILD. Aims and Objectives: The present study tries to establish that nintedanib has a therapeutic role to prevent lung function impairment in the post-recovery pulmonary fibrosis patients of COVID-19 disease. Materials and Methods: 50 adult patients having fibrotic changes in the computed tomography scan of the chest, following recovery from coronavirus disease, were chosen. They were divided into two categories. Both the categories were given the treatment of lung fibrosis as per the standard regimen. In addition, only one of the categories received the recommended dose of nintedanib. A pulmonary function test (PFT) was performed on the patients of both categories on day 1 and day 90. A comparison of the PFT variables was done by statistical analysis. Results: The PFT parameters of both groups were similar on day 1. On day 90, most of the spirometry variables of the patients administered with nintedanib along with the standard treatment regimen showed statistically significant improvement with respect to the values on day 1. The lung function test variables of the group receiving nintedanib were also significantly better than those not receiving it, as observed on day 90. Conclusion: As the spirometry variables of the patients following recovery of coronavirus disease with confirmed fibrosis of the lungs showed significant improvement after receiving nintedanib, it can be concluded that nintedanib may be useful in treating such cases.