A multicenter survey study of antifibrotic use for symptomatic patients with post-COVID-19 interstitial lung abnormalities.

Background: Little data exist on antifibrotic drugs for treating symptomatic patients with persistent interstitial lung abnormalities in the postacute phase of coronavirus disease 2019 (COVID-19). Herein, we describe the physician practices of prescribing pirfenidone and nintedanib for these patients and the physician-assessed response. Materials and Methods: This was a multicenter, retrospective survey study of subjects administered pirfenidone or nintedanib for post-COVID-19 interstitial lung abnormalities. Data on the demographic details, comorbidities, abnormalities on the computed tomography (CT) of the chest, treatment, antifibrotic drug use, and physician-assessed response were collected on a standard case record pro forma. We explored physician practices of prescribing antifibrotics (primary objective) and the physician-assessed response (secondary objective). Results: We included 142 subjects (mean age, 55.9 years; 16.2% women) at eight centers. The most common abnormalities on CT chest included ground glass opacities (75.7%), consolidation (49.5%), reticulation (43.9%), and parenchymal bands (16.8%). Of the 5701 patients discharged after hospitalization at six centers, 115 (2.0%) received antifibrotics. The drugs were prescribed an average of 26 days after symptom onset. One hundred and sixteen subjects were administered pirfenidone; 11 (9.5%) received the full dose (2400 mg/day). Thirty subjects were prescribed nintedanib; 23 (76.7%) received the full dose (300 mg/day). Of 76 subjects with available information, 27 (35.6%) and 26 (34.2%) had significant or partial radiologic improvement, respectively, according to the physician's assessment. Conclusions: Antifibrotic agents were administered to a minority of patients discharged after recovery from acute COVID-19 pneumonia. Larger, randomized studies on the efficacy and safety of these agents are required.

Consensus statement on: Favipiravir as an empirical therapy for influenza-like illness during COVID-19 pandemic

The COVID-19 pandemic continues to have a serious impact on the lives of millions of people worldwide. Empirical therapy is being used to reduce morbidity and mortality of COVID-19 patients. Favipiravir, which is an oral broad-spectrum anti-viral agent with proven efficacy against various RNA viruses, acceptable tolerability profile and favorable benefit-risk ratio in short term use, has got an emergency use authorization in many countries including India for the treatment of mild to moderate cases of COVID-19. It has demonstrated promising results in terms of rapid viral clearance, quick symptom control, and pulmonary radiographic improvement. Due to reasons such as lockdown, isolation, diagnostic delays, fear of quarantine or getting tested, cost, etc., the golden time period (first 24-48 hrs) is lost in COVID-19 patients which is crucial for initiating antiviral therapy. Therefore, the panel members of ‘Academy of Advanced Medical Education’ propose that favipiravir can be recommended in confirmed, early probable and possible cases of mild and moderate severity as an empirical therapy during current pandemic. It is important to counsel the patients and explain to them about the limited clinical evidences with favipiravir, therefore, a signed consent form from patient must be kept before initiating treatment. Well-designed double-blind controlled trials are urgently required to understand this further.