Comparison of the effectiveness of pirfenidone with corticosteroids in post-COVID fibrosis – A quasi experimental study

Abstract

Objective: To evaluate the effectiveness of corticosteroids with pirfenidone in patients of post-coronavirus disease-2019 pulmonary fibrosis in preventing long-term life-threatening sequelae.

Method: The quasi-experimental study was conducted at the Department of Pharmacology, Army Medical College, Rawalpindi, and the Department of Pulmonology, Pakistan Emirates Military Hospital, Rawalpindi, Pakistan, from January to December 2024, and comprised patients with post- coronavirus disease-2019 pulmonary fibrosis who were divided into Group-A receiving corticosteroids and Group-B receiving a combination of pirfenidone and corticosteroids. Pulmonary fibrosis was diagnosed on the basis of high-resolution computed tomography findings. The participants were subjected to 6-minute walk test and pulse-oximetry, while Warrick scores for pulmonary fibrosis were also noted for each participant at 3 and 6 months. Data was analysed using SPSS 26.

Results: Of the 40 patients, 20(50%) were in Group-A; 12(60%) males and 8 (40%) females with mean age 42.45±11.11 years. The other 20(50%) patients were in Group-B; 13(65%) males and 7(35%) females with mean age 43.15±8.64 years. Group-B showed higher improvement in 6-minute walk test compared to Group-A both at 90 days (p=0.189) and 180 days (p=0.002). Improvements in Oxygen saturation, Warrick score for fibrosis and fibrosis percentage were significantly higher in Group-B patients at 180-days follow-up as compared to Group-A (p<0.05).

Conclusion: The combination of pirfenidone and corticosteroids showed greater improvement in radiological and functional parameters compared to corticosteroids alone.

Key Words: Anti-fibrotic, Corticosteroid, Pirfenidone, Post-COVID pulmonary fibrosis, 6-minute walk test, Warrick score.