Pirfenidone
Pirfenidone is administered orally 3 times a day, 2 or 3 tablets each
time, for a period of 4 weeks or longer. The mechanism of action of
pyrfenidone has not yet been fully determined. However, existing data
indicate that pyrfenidone exerts both antifibrotic and anti-inflammatory
properties in a variety of in vitro systems and animal models of
pulmonary fibrosis (bleomycin-induced and transplant fibrosis). IPF is a
chronic fibrotic and inflammatory pulmonary disease caused by the
synthesis and release of pro-inflammatory cytokines including tumor
necrosis factor alpha (TNF-α) and interleukin-1-beta (IL-1β), and
pyrfenidone has been shown to reduce the accumulation of inflammatory
cells in response to various stimuli. Pirfenidone attenuates fibroblast
proliferation, protein and cytokine production associated with fibrosis
and increased biosynthesis and extracellular matrix accumulation in
response to cytokine growth factors such as transformative growth factor
beta (TGF-β) and platelet-derived growth factor (PDGF) (Figure
1 ).
The acute lung injury caused by SARS and 2003 were both related to the
inflammatory cytokine storm in patients. The biochemical test showed
abnormal increase in related indicators such as interleukin-8, and CT
images showed a medical ”white” lung”. According to the experience of
SARS treatment in 2003, the use of hormones will indeed help the
patients to alleviate their illness, but patients who survived SARS
either had too much hormone at that time and took too long. Although the
lungs could recover, but the femoral head was necrotic Either the amount
of hormones was very conservative at the time, which kept the lungs in
the storm of inflammatory factors, leading to the emergence of
irreversible pulmonary fibrosis. So is there a medicine that can
anti-inflammatory, reduce the load of hormone use, and have the effect
of treating and preventing pulmonary fibrosis complicated by severe
viral lung? At present, pirfenidone has achieved encouraging results in
the treatment of idiopathic Pulmonary Fibrosis (CTD-ILD) diseases. It is
particularly encouraging that the values announced at the 2019 ATS
Annual Conference suggest that pirfenidone has more anti-inflammatory
and anti-oxidant effects than its own outstanding anti-fibrotic ability.
The data shows early use, Its strong anti-SOD activity can effectively
inhibit IL-1beta and IL-4, and can open the prevention mode of pulmonary
interstitial fibrosis. Based on the above, this project intends to make
the following scientific assumptions: based on the homology of the
pathogens of the new coronavirus-infected pneumonia and the coronavirus
infection of pneumonia in 2003, the similarities in the occurrence and
development of the disease, that is, the pulmonary inflammatory storm
occurs first, and thereafter The progress of fibrosis and the
progressive decline of lung function and mortality are higher than those
of ordinary pneumonia. We hope that by adding pirfenidone as a treatment
program in addition to standard treatment, it will be a new and severe
type of coronavirus infection. Patient clinical treatment provides an
effective and practical method (24-26).
A trial is also starting
recently which will give strength to our hypothesis, ”A Study to
Evaluate the Efficacy and Safety of Pirfenidone With Novel Coronavirus
Infection” , conducted in Wuhan, China.