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.