【Evaluation of Pirfenidone for the Treatment of Acute Respiratory Distress Syndrome: A Case Report】 Full article: (Authored by Carlie Cressey Brown, et al., from University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences (USA), etc.)
Acute respiratory distress syndrome (ARDS) is an acute hypoxemic lung injury typically caused by a predisposing factor such as infection, aspiration, transfusion or shock. While accepted management includes lung protective ventilation strategies, there is currently no mainstay pharmacologic treatment for ARDS. Due to its anti-inflammatory, antioxidant, and antifibrotic properties, pirfenidone presents as a potential therapeutic option for patients with ARDS. This paper presents a case of a patient with ARDS secondary to pneumonia who was refractory to standard therapies and effectively treated with pirfenidone.
Background: Acute respiratory distress syndrome (ARDS) is an aggressive, inflammatory lung injury with a high mortality rate. While accepted management includes lung protective ventilation strategies, there is currently no mainstay pharmacologic treatment for ARDS. Adjunctive pharmacologic treatment may include glucocorticoids, neuromuscular blockade and inhaled pulmonary vasodilators. Due to its anti-inflammatory, antioxidant, and antifibrotic properties, pirfenidone presents as a potential therapeutic option for patients with ARDS. Case Report: We present a patient treated with pirfenidone for ARDS. Our patient was a 31-year-old man who presented to the hospital with dyspnea on exertion and concern for relapsed acute myeloid leukemia. After a complex hospital course, the off-label use of pirfenidone 801 mg three times daily was pursued to treat his ARDS. The patient’s ARDS resolved after 10 days of pirfenidone, with no adverse effects, and he was discharged. Conclusions: This case illustrates the potential utility of pirfenidone in the management of ARDS. After no improvement with widely accepted strategies including lung protective ventilation and steroids, the patient demonstrated recovery after the initiation of pirfenidone. We can infer correlation but not causation in this setting, prompting the need for further prospective randomized clinical trials to establish pirfenidone as a therapeutic option in ARDS.