The added value of pirfenidone to fight inflammation and fibrotic state induced by SARS-CoV-2
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POINT OF VIEW
The added value of pirfenidone to fight inflammation and fibrotic state induced by SARS-CoV-2 Anti-inflammatory and anti-fibrotic therapy could solve the lung complications of the infection? Francesco Ferrara 1
&
Giovanni Granata 2 & Chiara Pelliccia 3 & Raffaele La Porta 4 & Antonio Vitiello 1
Received: 1 May 2020 / Accepted: 23 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Aim SARS-CoV-2 infection has been divided by scientific opinion into three phases: the first as asymptomatic or slightly symptomatic and the second and the third with greater severity, characterized by a hyperinflammatory and fibrotic state, responsible for lung lesions, in some cases fatal. The development of antiviral drugs directed against SARS-CoV-2 and effective vaccines is progressing; meanwhile, the best pharmacological objective is related to the management of all the complications caused by this viral infection, mainly controlling the inflammatory and fibrotic state and preventing the infection from moving into the most serious phases. Subject and method Describe the scientific rationale related to the use of an antifibrotic therapy with pirfenidone, as monotherapy and/or in combination with anti-inflammatory drugs to manage and control complications of SARS-CoV-2 infection. Results Based on the scientific literature and epidemiological results and considering the pathophysiological, biological, and molecular characteristics of SARS-CoV-2, an antifibrotic drug such as pirfenidone as monotherapy or in combination with antiinflammatory drugs can be (acting early, at the right doses and at the right time) therapeutically effective to avoid serious complications during viral infection. The same approach can also be effective as postinfection therapy in patients with residual pulmonary fibrotic damage. Management of inflammation and fibrotic status with a combination therapy of pirfenidone and IL-6 or IL-1 inhibitors could represent a pharmacological synergy with added value. Conclusion In this article, we consider the role of antifibrotic therapy with pirfenidone in patients with SARS-CoV-2 infection on going or in the stage of postinfection with pulmonary fibrotic consequences. The scientific rationale for its use is also described. Keywords Pirfenidone . Fibrotic . Inflammation . Cytokine . Interleukin . SARS-CoV-2
Introduction The current global SARS-CoV-2 pandemic (COVID-19) represents a health crisis with few precedents in history;
A preliminary version of this report was made publicly available as a socalled preprint at a nonprofit repository (Authorea) with DOI number: https://doi.org/10.22541/au.158802198.88770371 * Francesco Ferrara [email protected] 1
Usl Umbria 1, Perugia, Italy
2
Asl Salerno, Salerno, Italy
3
Usl Umbria 2, Terni, Italy
4
Asur Marche, Ancona, Italy
at the time of writing this article, SARS-CoV-2 caused about 6.42 million infected and about 383,000 deaths [1]. SARS-CoV-2 infection, in the most severe cases, can cause tissue hyperinflamma
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