Bazdyrev Evgeny, Panova Maria, Zherebtsova Valeria, Burdenkova Alexandra, Grishagin Ivan, Novikov Fedor, Nebolsin Vladimir
Research Institute for Complex Issues of Cardiovascular Diseases, 6, Sosnoviy Blvd., 650002 Kemerovo, Russia.
Pharmenterprises LLC, Skolkovo Innovation Center, Bolshoi Blvd., 42(1), 143026 Moscow, Russia.
Pharmaceuticals (Basel). 2022 Dec 16;15(12):1574. doi: 10.3390/ph15121574.
Since the beginning of the COVID-19 pandemic, clinical, radiological, and histopathological studies have provided evidence that organizing pneumonia is a possible consequence of the SARS-CoV2 infection. This post-COVID-19 organizing pneumonia (PCOP) causes persisting dyspnea, impaired pulmonary function, and produces radiological abnormalities for at least 5 weeks after onset of symptoms. While most patients with PCOP recover within a year after acute COVID-19, 5-25% of cases need specialized treatment. However, despite substantial resources allocated worldwide to finding a solution to this problem, there are no approved treatments for PCOP. Oral corticosteroids produce a therapeutic response in a majority of such PCOP patients, but their application is limited by the anticipated high-relapse frequency and the risk of severe adverse effects. Herein, we conduct a systematic comparison of the epidemiology, pathogenesis, and clinical presentation of the organizing pneumonias caused by COVID-19 as well as other viral infections. We also use the clinical efficacy of corticosteroids in other postinfection OPs (PIOPs) to predict the therapeutic response in the treatment of PCOP. Finally, we discuss the potential application of a candidate anti-inflammatory and antifibrotic therapy for the treatment of PCOP based on the analysis of the latest clinical trials data.
自新冠疫情开始以来,临床、放射学和组织病理学研究已提供证据表明,机化性肺炎是感染新冠病毒的一种可能后果。这种新冠后机化性肺炎(PCOP)会导致持续的呼吸困难、肺功能受损,并在症状出现后至少5周内产生放射学异常。虽然大多数PCOP患者在急性新冠感染后一年内康复,但5%-25%的病例需要特殊治疗。然而,尽管全球投入了大量资源来寻找解决这一问题的方法,但目前尚无批准用于治疗PCOP的疗法。口服糖皮质激素在大多数此类PCOP患者中产生治疗反应,但其应用受到预期的高复发频率和严重不良反应风险的限制。在此,我们对新冠病毒以及其他病毒感染所致机化性肺炎的流行病学、发病机制和临床表现进行了系统比较。我们还利用糖皮质激素在其他感染后机化性肺炎(PIOPs)中的临床疗效来预测PCOP治疗中的治疗反应。最后,基于对最新临床试验数据的分析,我们讨论了一种候选抗炎和抗纤维化疗法在PCOP治疗中的潜在应用。