Pilot study: management with pentoxifylline in patients with chronic liver disease and COVID-19

Introduction and Objectives

This study aimed to improve the response to adjuvant treatment with pentoxifylline in patients with SARS-CoV-2 and previous chronic liver disease.

Materials and Methods

In the ISSSTE hospital of Zapopan for eight months, 51 patients with moderate to severe SARS-CoV-2 and chronic liver disease, 26 with cirrhosis and 25 with steatohepatitis were evaluated, with prior informed consent and endorsed by the ethics committee. They were administered pentoxifylline 400 mg for 28 days, in addition to supportive measures such as paracetamol 750 mg, celecoxib 100 mg, or anticoagulants (enoxaparin) in patients with D-dimer > 600 mg/dL and supplemental oxygen in patients with saturation < 90. Clinical, laboratory and mortality variables were analyzed. The trial was approved by the research ethics committee, and informed consent was obtained.

Results

They were patients with Covid-19 plus cirrhosis and steatohepatitis. They survived 100%, after 28 days of driving, in addition to avoiding admission to intensive care.

Discussion

Pentoxifylline is a methylxanthine with antioxidant, hemorheological, anti-inflammatory and immunomodulatory properties since it inhibits NF-KB (via JAK/STAT and 1KB), pro-inflammatory cytokines, phosphodiesterase, in addition to stimulating anti-inflammatory cytokines, interferon-gamma, growth factors, TGF beta and granulocyte growth factor. Also, antiviral, as in Japanese encephalitis virus, vaccine virus, Rotavirus, HPV, respiratory syncytial virus, HIV, HCV, etc.

Conclusions

This viremia is severe in vulnerable groups, particularly liver diseases. It is inferred that Pentoxifylline may be alternative management, as manifested in this group of patients who managed to survive. So, we suggest multicenter and randomized studies to know their real benefit.

Funding

The resources used in this study were from the hospital without any additional financing

Declaration of interest

The authors declare no potential conflicts of interest.

Table 1. Demographic, biochemical and symptomatology characteristics of the two groups

Previous pathologies	Steatohepatitis	Liver cirrhosis
Age	55.64	60,84
Gender	72% women - 28% men	42% women – 58% men
BMI	30.76	27.84
Comorbidities
Overweight / obesity	100%	100%
DM 2	31%	20%
Alcoholism	0%	27%
Autoimmune disease	0%	4%
Laboratory
AST	42.24	56.76
ALT	50.25	69.90
DHL	308.2	315.6
Platelets	170	100.38
Ferritin	496.24	592.5
D-dimer	530.54	1,064
Lymphocytes	35.2	29.96
ESR	32.32	30.06
PCR	49	47.03
Oxygen saturation	85.24	85.69
Clinic:
Cough	16 (64%)	14 (54%)
Dyspnea	13 (52%)	12 (46%)
Pneumonia	5 (20%)	8 (32%)
Asthenia	6 (24%)	6 (24%)
Fever	2 (8%)	13 (52%)
Headache	3 (12%)	8 (31%)
Anosmia	1 (4%)	1 (4%)
Shivers	1 (4%)	1 (4%)
Arthralgia	3 (12%)	2 (8%)
Diarrhea	1 (4%)	2 (8%)