Evaluation of Pirfenidone for the Treatment of Acute Respiratory Distress Syndrome: A Case Report

TL;DR

A 31-year-old man with ARDS showed recovery after being treated with pirfenidone, suggesting it may be a potential treatment option.

Contribution

This case report explores the off-label use of pirfenidone for ARDS, highlighting its potential therapeutic role.

Findings

The patient's ARDS resolved after 10 days of pirfenidone treatment with no adverse effects.

Pirfenidone showed potential utility after standard treatments failed to improve the patient's condition.

Further clinical trials are needed to confirm pirfenidone's efficacy in ARDS.

Abstract

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 anti-fibrotic properties, pirfenidone presents as a potential therapeutic option for patients with ARDS.

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.

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.

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