Comparison of pirfenidone and corticosteroid treatments at the COVID‐19 pneumonia with the guide of artificial intelligence supported thoracic computed tomography

Abstract

Aim We aimed to investigate the effect of short‐term pirfenidone treatment on prolonged COVID‐19 pneumonia. Method Hospital files of patients hospitalised with a diagnosis of critical COVID‐19 pneumonia from November 2020 to March 2021 were retrospectively reviewed. Chest computed tomography images taken both before treatment and 2 months after treatment, demographic characteristics and laboratory parameters of patients receiving pirfenidone + methylprednisolone (n = 13) and only methylprednisolones (n = 9) were recorded. Pulmonary function tests were performed after the second month of the treatment. CT involvement rates were determined by machine learning. Results A total of 22 patients, 13 of whom (59.1%) were using methylprednisolone + pirfenidone and 9 of whom (40.9%) were using only methylprednisolone were included. When the blood gas parameters and pulmonary function tests of the patients were compared at the end of the second month, it was found that the FEV1, FEV1%, FVC and FVC% values were statistically significantly higher in the methylprednisolone + pirfenidone group compared with the methylprednisolone group ( P = .025, P = .012, P = .026 and P = .017, respectively). When the rates of change in CT scans at diagnosis and second month of treatment were examined, it was found that the involvement rates in the methylprednisolone + pirfenidone group were statistically significantly decreased ( P < .001). Conclusion Antifibrotic agents can reduce fibrosis that may develop in the future. These can also help dose reduction and/or non‐use strategy for methylprednisolone therapy, which has many side effects. Further large series and randomised controlled studies are needed on this subject.

CD147 contributes to SARS-CoV-2-induced pulmonary fibrosis

“…As antifibrotic agents that interfere with processes of pulmonary fibrosis, nintedanib and pirfenidone might provide novel therapeutic approaches for minimizing post-COVID-19 fibrosis. 41,42 However, it is likely that nintedanib may increase the risk of bleeding when used together with anticoagulants. 43 In addition, both nintedanib and pirfenidone may lead to hepatotoxicity, which will further increase the likelihood of liver dysfunction often experienced by COVID-19 patients.…”

Effect of Pirfenidone on Risk of Pulmonary Fibrosis in COVID-19 Patients Experiencing Cytokine Storm

“…Another encouraging trend in favor of pirfenidone was investigated in the Acat M. et al study that was conducted on hospitalized patients diagnosed with severe COVID-19 pneumonia, as it was discovered that pirfenidone can prevent the development of fibrosis. In addition, it can aid in dose reduction and/or non-use strategies for methylprednisolone therapy, which is associated with numerous adverse effects [ 36 ]. These observations were similar to the conclusions of a study that was carried out on patients with severe COVID-19 infection, and indicated that beginning pirfenidone medication as soon as possible is associated with a better treatment and survival outcome compared to corticosteroids.…”

Efficacy of Pirfenidone as Antifibrotic Agent in Patients with Post Covid Fibrosis

“…Our patients were randomly separated into 2 groups. First group (25 cases) got pirfenidone in a dose of 267 mg tds at 1 st week, which was further raised in weekly dosage increments to a maximum of 2400 mg (13) , in addition to 20 mg/day corticosteroids (prednisolone). Second group (25 cases) received 20 mg /day corticosteroids (prednisolone) (14) .…”

“…First group (25 patients) received pirfenidone beginning in the first week at a dose of 267 mg tds and progressively increasing to a maximum of 2400 mg in weekly dose additions after that (13) in combination with 20 mg/day corticosteroids (prednisolone).…”