Pirfenidone: A novel hypothetical treatment for COVID-19

Med Hypotheses. 2020 Nov:144:110005. doi: 10.1016/j.mehy.2020.110005. Epub 2020 Jun 17.


Cytokine storm, multiorgan failure, and particularly acute respiratory distress syndrome (ARDS) is the leading cause of mortality and morbidity in patients with COVID-19. A fulminant ARDS kills the majority of COVID-19 victims. Pirfenidone (5-methyl-1-phenyl-2-[1H]-pyridone), is a novel anti-fibrotic agent with trivial adverse effects. Pirfenidone is approved for the treatment of Idiopathic Pulmonary Fibrosis (IPF) for patients with mild to moderate disease. Pirfenidone could inhibit apoptosis, downregulate ACE receptors expression, decrease inflammation by several mechanisms and ameliorate oxidative stress and hence protect pneumocytes and other cells from COVID-19 invasion and cytokine storm simultaneously. Based on the pirfenidone mechanism of action and the known pathophysiology of COVID-19, I believe that pirfenidone has the potential for the treatment of COVID-19 patients.

Keywords: Acute respiratory distress syndrome; Angiotensin converting enzyme receptor; COVID-19; Cytokine storm; Inflammation; Oxidative stress; Pirfenidone; Treatment.

MeSH terms

  • Alveolar Epithelial Cells / drug effects
  • Angiotensin-Converting Enzyme 2 / biosynthesis
  • Angiotensin-Converting Enzyme 2 / genetics
  • Animals
  • Anti-Inflammatory Agents / pharmacology
  • Anti-Inflammatory Agents / therapeutic use*
  • Apoptosis / drug effects
  • COVID-19 / complications
  • COVID-19 Drug Treatment*
  • Cytokine Release Syndrome / etiology
  • Cytokine Release Syndrome / prevention & control
  • Disease Models, Animal
  • Down-Regulation / drug effects
  • Drug Repositioning*
  • Humans
  • Lipid Peroxidation / drug effects
  • Oxidative Stress / drug effects
  • Pyridones / pharmacology
  • Pyridones / therapeutic use*
  • Receptors, Virus / biosynthesis
  • Receptors, Virus / genetics


  • Anti-Inflammatory Agents
  • Pyridones
  • Receptors, Virus
  • pirfenidone
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2