Improved post-covid interstitial lung disease outcomes using a novel therapeutic regimen

SESSION TITLE: Chest Infections Posters 9 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm PURPOSE: The estimated incidence of Long COVID syndrome is 10-35%, and it may reach 85% in hospitalized patients. Long COVID management continues to be a major challenge, particularly for patients with persistent oxygen requirements. We developed a novel treatment protocol that combined high-dose steroids with a cell cycle inhibitor with the goals to reduce post-COVID inflammation, decrease oxygen requirements, and improve CT findings. METHODS: We retrospectively reviewed clinical and laboratory data on long COVID patients who were seen in the UT Southwestern Post-COVID Lung Clinic between 01/01/2020-09/01/2022. Patients were referred to the clinic at least 3 months after developing COVID. Twenty-four patients received steroids (40 mg/day) in combination with a cell cycle inhibitor (mycophenolate mofetil) . All patients were on supplemental oxygen and/or had bilateral ground glass opacities (GGO) on the CT Thorax. RESULTS: In treated patients, mean oxygen requirements at rest (2.13 L /NC (SD+/-1.83) decreased to 0.75 (SD+/-1.26) at 7 months follow up, p=0.0005. Mean oxygen requirements with exertion decreased from 2.90 L /NC (SD+/-1.64) to 1.58 (SD+/-2.04) at 6 months follow-up, p=0.0072. Nine patients were weaned off oxygen both at rest and with exertion, while 10 patients were weaned off oxygen at rest. The mean distance walked in meters (m) during the 6-minute walk test increased from 249 m (SD+/-66.1) to 289m (SD +/-75.7), p=0.4160. Patients’ lung function, by serial FVC1 measurements, improved to 2.24 L (SD+/-0.63) compared to baseline 2.00 L (SD+/-0.53). In 19 patients who had follow-up CT thorax imaging, GGO improved in 8 patients, remained stable in 9, and worsened in 1 patient. Fibrosis improved in 6 patients, remained stable in 12, and worsened in 1 patient. None of the patients had a previous diagnosis of Interstitial Lung Disease. Demographic data of post-COVID patients in this study included a mean age of 57.3 years; gender: 59% male, 41% female; race: 30% Hispanic, 70% Caucasian. CONCLUSIONS: Our retrospective analysis of 24 patients with post-COVID Interstitial Lung Disease shows that the administration of steroids in combination with a cell cycle inhibitor was associated with decreased oxygen requirements and PFT improvements at 6-month follow-up. CLINICAL IMPLICATIONS: Our findings suggest that patients with post-COVID syndrome who develop Interstitial Lung Disease may be safely managed with a combined steroid and cell cycle inhibitor (MMF) regimen in order to improve lung function and functional deficits associated with ILD. This combination demonstrated improved outcomes such as decreased oxygen requirements and improved CT findings, which may enable long-term improvement for patients with post-COVID syndrome. Additional clinical trials are needed to investigate the effectiveness of our novel treatment protocol for improving outcomes in post-COVID patients with persistent respiratory symptoms and/or elevated oxygen requirements. DISCLOSURES: No disclosure on file for Amit Banga No disclosure on file for Srinivas Bollineni No relevant relationships by Brisa Garcia No relevant relationships by Ariana Ishaq No relevant relationships by John Joerns No relevant relationships by Vaidehi Kaza No relevant relationships by Adrian Lawrence No relevant relationships by Luke Mahan No relevant relationships by Manish Mohanka No relevant relationships by Alice Ryan No relevant relationships by Christine Shedd No relevant relationships by Lance Terada No relevant relationships by Irina Timofte No relevant relationships by Fernando Torres