What Medicine Removes Fibrosis? Understanding the Limits of Anti-Fibrotic Treatments

October 11, 2025 •

4 min read

Chronic fibrotic disorders account for up to 45% of all deaths in the industrialized world. While the holy grail of treatment—a medicine that removes fibrosis completely—remains elusive, significant strides have been made with medications that effectively slow the progression of scarring in affected organs, greatly improving patient outcomes.

Quick Summary

Fibrosis, or organ scarring, is largely irreversible with current medications, but effective treatments exist to slow its progression. Anti-fibrotic drugs target conditions like pulmonary and liver fibrosis to manage symptoms and preserve organ function.

Key Points

Fibrosis is Scar Tissue: Fibrosis is the formation of scar tissue that replaces healthy, functional tissue, causing organs like the lungs and liver to stiffen.
No Medicine Removes Fibrosis: While research is ongoing, no current medication can completely remove mature fibrotic scar tissue. The process is largely irreversible.
Medications Slow Progression: Modern anti-fibrotic drugs, such as pirfenidone (Esbriet®), nintedanib (Ofev®), and nerandomilast (Jascayd®), are designed to slow the worsening of fibrosis, not remove it.
Treatments for Specific Organs: Different medications are used for fibrosis in different organs. Resmetirom (Rezdiffra) and semaglutide (Wegovy) are approved for MASH-related liver fibrosis, while others target pulmonary fibrosis.
Focus on Management: A comprehensive treatment plan includes anti-fibrotic drugs, managing the underlying cause of damage, and supportive care like oxygen therapy and rehabilitation.
Future Research Holds Promise: Scientists are actively developing and testing new drug candidates that target various pathways involved in fibrosis, potentially leading to more advanced treatments.

The Irreversible Nature of Fibrotic Scarring

Fibrosis is the result of the body's overzealous wound-healing process, where chronic inflammation leads to an excessive buildup of fibrous connective tissue, primarily collagen. This scar tissue replaces functional tissue, causing the affected organ to stiffen and lose function. Crucially, once mature fibrotic scar tissue has formed, it is largely considered irreversible and cannot be completely removed by current medications. Instead, the goal of modern anti-fibrotic therapies is to intervene in the biological pathways that drive this scarring, thereby slowing its progression and preserving as much organ function as possible.

Medications for Pulmonary Fibrosis

For idiopathic pulmonary fibrosis (IPF), a progressive and often fatal lung disease, two anti-fibrotic agents have been mainstays of treatment for years, with a newer option recently receiving approval. These medications target the cellular mechanisms that promote scarring in the lungs, aiming to preserve lung function.

Pirfenidone (Esbriet®): This drug has both anti-inflammatory and anti-fibrotic properties. It has been shown in clinical trials to slow the decline in lung function and may improve mortality rates in some patients. Common side effects can include nausea, decreased appetite, and a sun-sensitive rash.
Nintedanib (Ofev®): A tyrosine kinase inhibitor, nintedanib blocks several cellular signaling pathways involved in the formation of fibrotic tissue. It is approved for IPF and other chronic fibrosing interstitial lung diseases (ILDs). Patients taking nintedanib may experience side effects such as diarrhea, nausea, and elevated liver enzymes.
Nerandomilast (Jascayd®): Recently approved by the FDA, nerandomilast is a preferential inhibitor of phosphodiesterase 4B (PDE4B) with both anti-fibrotic and immunomodulatory effects. It offers a novel mechanism of action for slowing the decline of lung function in adults with IPF.

Medications for Liver Fibrosis

Liver fibrosis often stems from chronic damage caused by conditions like metabolic dysfunction-associated steatohepatitis (MASH, formerly NASH). While lifestyle modifications are the first line of defense, medications are now emerging to treat the underlying cause and, in some cases, reverse early-stage fibrosis.

Resmetirom (Rezdiffra): This daily pill is the first treatment approved for MASH-related liver scarring. It works by activating a thyroid hormone receptor that helps reduce liver fat accumulation. In clinical trials, it significantly resolved MASH and improved fibrosis in some patients. Resmetirom is prescribed alongside a healthy diet and lifestyle.
Semaglutide (Wegovy): Originally approved for diabetes and weight management, semaglutide has now been approved for treating MASH with moderate-to-advanced fibrosis. A phase 3 trial showed a significant percentage of patients achieved MASH resolution without fibrosis worsening after 72 weeks. Its mechanism is related to weight loss and other factors that improve liver health.

Future Treatments and Non-Pharmacological Interventions

Research into new anti-fibrotic drugs continues to evolve, with clinical trials exploring novel targets and mechanisms. For example, drugs targeting the LPA1 receptor or the STAT3 pathway are under investigation. Beyond medication, supportive therapies play a vital role in managing fibrosis across different organs.

Comparison Table: Key Anti-Fibrotic Medications


Medication	Condition Treated	Primary Mechanism	Effect on Fibrosis	Key Side Effects	Availability/Approval	Authority
Pirfenidone (Esbriet®)	Idiopathic Pulmonary Fibrosis (IPF)	Anti-inflammatory, anti-fibrotic	Slows progression	Nausea, rash (photosensitivity), GI issues	FDA-approved for IPF	,
Nintedanib (Ofev®)	IPF, Progressive Fibrosing ILDs	Tyrosine kinase inhibitor	Slows progression	Diarrhea, nausea, elevated liver enzymes	FDA-approved for IPF and other fibrosing ILDs	,
Nerandomilast (Jascayd®)	Idiopathic Pulmonary Fibrosis (IPF)	Preferential PDE4B inhibitor	Slows decline in lung function	Well-tolerated	Recently FDA-approved for IPF	,
Resmetirom (Rezdiffra)	MASH-related liver fibrosis	Thyroid hormone receptor agonist	Can improve fibrosis in some cases	Diarrhea, nausea	FDA-approved for MASH	,
Semaglutide (Wegovy)	MASH-related liver fibrosis	GLP-1 receptor agonist	Resolves MASH, may improve fibrosis	Nausea, vomiting, GI issues	FDA-approved for MASH

List of Non-Pharmacological Fibrosis Treatments

Treatment of Underlying Conditions: Managing the root cause of fibrosis, such as quitting smoking for pulmonary fibrosis or controlling diabetes for liver fibrosis, is a critical step.
Oxygen Therapy: For pulmonary fibrosis, supplemental oxygen can help ease symptoms like shortness of breath and reduce strain on the heart.
Pulmonary Rehabilitation: These programs include exercise, breathing techniques, and education to help patients with lung fibrosis improve their quality of life.
Diet and Exercise: Lifestyle changes are particularly effective for liver fibrosis related to MASH. Proper nutrition and regular physical activity can help manage the condition.
Lung Transplantation: For severe, advanced pulmonary fibrosis, a lung transplant may be the best option for some patients.

Conclusion

While a medication that removes fibrosis completely has yet to be developed, significant advances in treatment have transformed the management of chronic fibrotic diseases. For conditions like IPF and MASH-related liver disease, effective anti-fibrotic drugs can dramatically slow the progression of scarring, thereby preserving organ function and improving patient outcomes. These pharmacological interventions are most effective when combined with targeted management of the underlying condition and supportive therapies. The ongoing research and development of new therapies targeting specific fibrotic pathways offer continued hope for more effective treatments in the future.

American Lung Association: Pulmonary Fibrosis Medications

Disclaimer

The information provided in this article is for general informational purposes only and does not constitute medical advice. Consult a healthcare professional for diagnosis and treatment of any medical condition.

Frequently Asked Questions

No, significant fibrosis, or scarring, in the lungs is considered irreversible with current treatments. However, medications like pirfenidone and nintedanib can significantly slow the rate at which lung function declines, and new therapies like nerandomilast offer additional options for managing the disease.

In some cases, yes. Unlike mature scar tissue in the lungs, early to moderate liver fibrosis can sometimes be improved or even reversed if the underlying cause is addressed. Medications like resmetirom and semaglutide, used for MASH-related fibrosis, have shown promising results in resolving the condition and improving scarring in clinical trials.

Anti-fibrotic medications work by targeting the cellular and molecular pathways that cause excessive scar tissue formation. For example, nintedanib is a tyrosine kinase inhibitor, while nerandomilast inhibits a specific enzyme (PDE4B). These mechanisms disrupt the signaling that drives fibrosis, thereby slowing the process down.

Side effects vary by medication but can include gastrointestinal issues like nausea, diarrhea, and vomiting. Pirfenidone can also cause photosensitivity, while nintedanib may elevate liver enzymes, requiring regular blood test monitoring.

For very advanced pulmonary fibrosis, a lung transplant can be the most effective treatment, offering improved quality of life and longevity. However, it is not a 'cure' in the traditional sense, as it involves significant risks and requires lifelong medication to prevent rejection.

The evidence does not support that any natural remedies can remove established fibrosis. While a healthy diet and lifestyle are crucial for overall health and can support liver and lung function, they should not replace proven medical treatments. Always consult your doctor before trying alternative therapies.

Fibrotic tissue is a highly organized and stable matrix of collagen that replaces healthy tissue. The body's natural repair mechanisms are complex, and reversing this deep-seated scarring without causing further harm to the delicate organ structure is incredibly challenging. Most treatments therefore focus on stopping the process from advancing.