Cancer chemotherapy linked to Post-COVID Pulmonary Fibrosis

In the larger context of battling COVID-19, the study published in The Lancet Regional Health - Americas contributes valuable insights into the factors of recent rituximab or cancer chemotherapy influencing pulmonary fibrosis development post-infection.

Pulmonary fibrosis, a condition marked by the destruction of lung tissue, has been a concerning aftermath of SARS-CoV-2 infections, increasing morbidity and mortality in many cases. In a significant stride towards understanding this phenomenon, Ayodeji Adegunsoye and team have investigated whether specific pharmacotherapies could be linked to varying incidences of post-COVID-19 pulmonary fibrosis.

Utilizing the robust dataset from the National COVID-19 Cohort Collaboration (N3C) Data Enclave, encompassing COVID-19 data from across the United States, scientists delved into pulmonary fibrosis incidence occurring at least 60 days after COVID-19 diagnosis. The study focused on adults who were hospitalized between January 1st, 2020, and July 6th, 2022, and who did not have pre-existing pulmonary fibrosis.

Out of a staggering 5,923,394 COVID-19 patients, the analysis concentrated on 452,951 hospitalized adults. Among them, the incidence rate of post-COVID-19 pulmonary fibrosis was found to be 1.1 per 100-person-years. Strikingly, 277,984 of these hospitalized adults were included in the primary analysis. The study employed propensity scores to carefully match drug-exposed cohorts and unexposed cohorts (1:1) based on influential covariates.

The findings of this comprehensive study unveiled intriguing associations. Rituximab, used to treat various conditions including certain autoimmune diseases and cancers, was notably linked to a 2.5-fold increase in post-COVID-19 pulmonary fibrosis risk. Similarly, cancer chemotherapy displayed a 1.6-fold elevated risk, while corticosteroid use exhibited a more modest 1.2-fold increase. In contrast, amiodarone, a medication commonly prescribed for heart rhythm issues, showed no significant association with post-COVID-19 pulmonary fibrosis risk.

Sensitivity analyses were also conducted, examining pulmonary fibrosis incidence at different post-hospitalization time frames and among a COVID-19 negative hospitalized population. Interestingly, pre-existing corticosteroid use did not consistently correlate with post-COVID-19 pulmonary fibrosis risk. 

Source:

Adegunsoye, A., Baccile, R., Best, T. J., Zaksas, V., Zhang, H., Karnik, R., Patel, B. K., Solomonides, A. E., Parker, W. F., & Solway, J. (2023). Pharmacotherapy and pulmonary fibrosis risk after SARS-CoV-2 infection: a prospective nationwide cohort study in the United States. In The Lancet Regional Health - Americas (Vol. 25, p. 100566). Elsevier BV. https://doi.org/10.1016/j.lana.2023.100566