Early intervention with anti-fibrotic pirfenidone is effective than corticosteroids in preventing pulmonary fibrosis in severe COVID pneumonia patients

Nisar, Sobia; Tanvir, Masood; Wagay, Imran; Ahmed, RabiaNazir; Maqbool, Muzaffar; Kareem, Ozaifa; Muzaffer, Umar

doi:10.4103/cmrp.cmrp_110_21

Cited by 7 publications

(4 citation statements)

References 36 publications

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“…In the beginning of the trial, the parameters were analyzed, and at the end of the period, the antifibrotic effects of PFN were shown to be greater than those of corticosteroids. According to these observations, early therapy with PFN in severely affected individuals with COVID-19 may minimize the likelihood of developing post-COVID-19 pulmonary fibrosis [ 47 ]. So, concurrent use of steroids and antifibrotics is also being investigated, but the long-term outcomes are unknown.…”

Section: Treatments Of Post-covid Pulmonary Fibrosismentioning

confidence: 99%

Post-COVID-19 Pulmonary Fibrosis: Facts—Challenges and Futures: A Narrative Review

Duong-Quy,

Vo-Pham-Minh,

Tran-Xuan

et al. 2023

Pulm Ther

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Patients with coronavirus disease 2019 (COVID-19) usually suffer from post-acute sequelae of coronavirus disease 2019 (PASC). Pulmonary fibrosis (PF) has the most significant long-term impact on patients’ respiratory health, called post-COVID-19 pulmonary fibrosis (PC19-PF). PC19- PF can be caused by acute respiratory distress syndrome (ARDS) or pneumonia due to COVID-19. The risk factors of PC19-PF, such as older age, chronic comorbidities, the use of mechanical ventilation during the acute phase, and female sex, should be considered. Individuals with COVID-19 pneumonia symptoms lasting at least 12 weeks following diagnosis, including cough, dyspnea, exertional dyspnea, and poor saturation, accounted for nearly all disease occurrences. PC19-PF is characterized by persistent fibrotic tomographic sequelae associated with functional impairment throughout follow-up. Thus, clinical examination, radiology, pulmonary function tests, and pathological findings should be done to diagnose PC19-PF patients. PFT indicated persistent limitations in diffusion capacity and restrictive physiology, despite the absence of previous testing and inconsistency in the timeliness of assessments following acute illness. It has been hypothesized that PC19-PF patients may benefit from idiopathic pulmonary fibrosis treatment to prevent continued infection-related disorders, enhance the healing phase, and manage fibroproliferative processes. Immunomodulatory agents might reduce inflammation and the length of mechanical ventilation during the acute phase of COVID-19 infection, and the risk of the PC19-PF stage. Pulmonary rehabilitation, incorporating exercise training, physical education, and behavioral modifications, can improve the physical and psychological conditions of patients with PC19-PF.

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Section: Treatments Of Post-covid Pulmonary Fibrosismentioning

confidence: 99%

Post-COVID-19 Pulmonary Fibrosis: Facts—Challenges and Futures: A Narrative Review

Duong-Quy,

Vo-Pham-Minh,

Tran-Xuan

et al. 2023

Pulm Ther

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“…Our study finding suggests concurrent initiation of antifibrotic added with steroid has momentous benefit on improved lung function over steroid only in severely ill COVID patients. However, Tanvir et al 19 found that early initiation of antifibrotic in severe COVID infection plays a compelling role than steroid to improve lung function though they did not find any improvement in 6MWD. In contrast, our study shows significant improvement in 6MWD in antifibrotic group as well along with improved SpO 2 .…”

Section: Discussionmentioning

confidence: 95%

Post-COVID Lung Function with Steroid and/or Antifibrotic in A Tertiary Hospital of Bangladesh

Ahmed,

Baqui Billah,

Md Zahir

et al. 2024

Int. J. Hum. Health Sci.

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Background: Antifibrotic medication with or without steroid might be beneficial to prevent this postcovid fibrotic event; however, evidence could not establish it yet.Objective: To assess the effects of steroid and antifibrotics on the changes of SPO2 and 6MWD in COVID-19 patients whether antifibrotic has any beneficial effect combined with steroid to improve lung function.Methods: This quasi-experimental study was conducted on 76 moderate to severe COVID-19 patients admitted in Sher-e-Bangla Medical College Hospital, Barishal, Bangladesh, between June 2020 and June 2021. After recording the SPO2 and 6MWD, we gave steroid to 57 patients while the rest 19 patients received steroid and antifibrotic depending on severity. We followed the patients after 1 week, 6 weeks and 12 weeks of discharge to determine their SPO2 and 6MWD change as outcome variable.Results: We recorded nearly 83% improvement (n=63) of post Covid respiratory complains as evidenced by improved SPO2 of 76.9% from baseline to 96.7% in steroid group and from 74.6% to 95.6% in antifibrotic group (p<0.001). The 6MWD test also improved from 62 meter (p<0.001). Similarly, there was a significant improvement of 6MWD test from 53.1, 125.0 and 133.4 meter in 1st follow up, 2nd follow up and 3rd follow up respectively (p<0.001). On further analysis, we found that the antifibrotic treatment improved SPO2 and 6MWD test better than steroid only treatment group.Conclusion: Antifibrotic treatment with steroid improves pulmonary function better than steroid only in terms of SPO2 and 6MWD.International Journal of Human and Health Sciences Vol. 08 No. 01 Jan’24 Page: 38-43

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“…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. This is especially true for patients who are at higher risk, such as the elderly and those who have comorbidities [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Based on a previous trial [ 30 ], A minimum sample size of n = 92 patients was indicated for the current study based on 90% power to detect an effect size f2 of 0.704, assuming a two-sided tail hypothesis and an alpha-level = 0.05. Considering a possible loss of about 10% of patients, the sample size was increased to 100 patients.…”

Section: Methodsmentioning

confidence: 99%

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

Boshra

Warda

Sayed³

et al. 2022

Healthcare

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Objectives: Severe stages of COVID-19 infection have been associated with the excessive discharge of pro-inflammatory mediators such as cytokines, resulting in lung deterioration, which progresses rapidly to lung fibrosis leading to acute respiratory distress syndrome. In this investigation, the efficacy and safety of the novel antifibrotic and anti-inflammatory agent, Pirfenidone, were assessed in COVID-19 patients with pulmonary fibrosis secondary to cytokine storm. In this randomized controlled study, we assigned 100 adult COVID-19 patients cytokine storm and admitted to the intensive care isolation unit into either pirfenidone added to the standard therapy (n = 47), or the standard protocol only (n = 53). High-resolution computed tomography of the chest was performed in all patients to evaluate fibrotic lesions and their progression. The results showed that the percentage of patients who developed pulmonary fibrosis during cytokine storm onset in the pirfenidone group relative to the standard group was 29.8% and 35.8%, respectively, with no significant difference between the two groups; while there was a significant increase in the proportion of patients discharged from the isolation unit with pulmonary fibrosis without progression in fibrotic lesions in the pirfenidone group compared to the standard group (21.3% and 5.7%, respectively). Furthermore, there was a significant difference concerning liver enzyme elevation and GIT disturbance incidences in the studied groups (p = 0.006 and 0.01, respectively). Our findings show that Pirfenidone inhibits fibrosis advancement in COVID-19 patients with pulmonary fibrosis and is associated with hepatotoxicity and GI distress. It may be beneficial in patients with mild to moderate COVID-19-induced pulmonary fibrosis; however, additional research is necessary.

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Early intervention with anti-fibrotic pirfenidone is effective than corticosteroids in preventing pulmonary fibrosis in severe COVID pneumonia patients

Cited by 7 publications

References 36 publications

Post-COVID-19 Pulmonary Fibrosis: Facts—Challenges and Futures: A Narrative Review

Post-COVID-19 Pulmonary Fibrosis: Facts—Challenges and Futures: A Narrative Review

Post-COVID Lung Function with Steroid and/or Antifibrotic in A Tertiary Hospital of Bangladesh

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

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