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.