Pulmonary artery targeted therapy in treatment of COVID-19 related ARDS. Literature review

Abstract

Introduction The most grievous complication of the COVID-19 is the acute respiratory distress syndrome. A specific, rescue treatment for rapidly deteriorating patients should emerge to improve respiratory function and help patients to survive the most challenging period. Drugs used in targeted therapy of pulmonary arterial hypertension (PAH) appears to be suitable for this task and this article describes their potential for treatment of severe cases of COVID-19. Methods The authors reviewed the following databases for randomized controlled trials, reviews and meta-analyses published up to July 2020: Pubmed, Scopus, Google Scholar, Cochrane Database and ClinicalKey. The authors included every study contributory to the assessment of the potential of drugs used in targeted PAH therapy in treatment of COVID-19. Results Endothelin receptor antagonists, phosphodiesterase 5 inhibitors, riociguat and prostacyclin have proven ani-inflammatory effect and reduce pulmonary artery blood pressure, lung oedema and remodelling. Bosentan shows antiviral properties and sildenafil, as well as epoprostenol, inhibits apoptosis of lung epithelial cells. Among patients with lung lesions the decrease of pulmonary blood pressure can lead to increase of ventilation/perfusion mismatch and decrease of blood oxygenation. Conclusions Among all assessed drugs bosentan, sildenafil and epoprostenol appear to be most promising and a combination of these drugs should be considered due to synergism. The targeted PAH therapy in treatment of COVID-19 associated ARDS could be a useful tool saving lives of patients with severe SARS-CoV-2 infection, however, its introduction should be investigated and monitored very carefully as it can lead to transient deterioration of patient condition.

Potential long-term effects of SARS-CoV-2 infection on the pulmonary vasculature: Multilayered cross-talks in the setting of coinfections and comorbidities

“…An additional issue is whether drugs currently used in the treatment of PH and lung fibrosis can benefit patients with PVD associated to long COVID-19. Phosphodiesterase 5 inhibitors, endothelin-1 receptor antagonists, soluble guanylyl cyclase stimulators, prostacyclin analogues, and antifibrotic drugs (pirfenidone and nintedanib) are potentially useful for long COVID-19 patients, but only small and inconclusive clinical trials have been conducted so far [ 243 , 244 ].…”

Recent Advances and Future Prospects of Treatment of Pulmonary Hypertension

“…In addition, Puk et al have shown that endothelin receptor antagonists, phosphodiesterase 5 inhibitors, riociguat, and prostacyclin with its synthetic analogs could help treat COVID-19, as their beneficial effect on lungs in ARDS was reported in many studies. 42 …”

Right Ventricular Hypertrophy among COVID-19 Patients

“…Thus, a goal of treatment of patients hospitalized with COVID-19 should be to reduce the occurrence of PH. Drugs that were used in targeted therapy for PH prior to the pandemic, including bosentan, sildenafil and epoprostenol, have been recommended for treating patients experiencing acute respiratory distress syndrome during COVID-19 and might therefore help to achieve that goal [38]. Another treatment that has been suggested for use during COVID-19 to reduce pulmonary arterial pressure and prevent right ventricular dysfunction is inhaled nitric oxide.…”