Pentoxifylline in patients with COVID‑19 and with liver cirrhosis or metabolic dysfunction‑associated steatotic liver disease: Emerging insights

Coronavirus (CoV) disease 2019 (COVID‑19) deteriorates existing hepatopathies, such as liver cirrhosis and metabolic‑associated syndrome liver disease (MASLD), which in turn increases the risk of serious complications. The pathophysiology of COVID‑19 includes inflammation, proinflammatory cytokine storms, oxidative stress and fibrosis. Notably, pentoxifylline (PTX) blocks nuclear factor‑κB activity, thus inhibiting the secretion of proinflammatory cytokines, and is an antioxidant and antifibrotic agent. The present study reported on the use of PTX in 20 patients with liver cirrhosis (13 men, 7 women) of different etiologies and in 25 patients with MASLD (16 women, 9 men) infected with severe acute respiratory syndrome‑CoV‑2; age range of all patients, 29‑83 years. Firstly, the detection of CoV‑2 was confirmed by PCR. All patients received PTX (400 mg twice daily; per os) for 8 weeks, alongside standard care provided for COVID‑19 symptoms and for their liver condition. In all patients, the following inflammatory markers were assessed at the beginning and at the end of the study: C‑reactive protein, D‑dimer, ferritin, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase (LDH), platelet count and oxygen saturation. Statistical analysis was performed using the Wilcoxon signed‑rank test. At the end of the study, no patient required admission to the intensive care unit and no patient fatalities were noted. Notable improvement was noted in seven of the eight inflammatory markers in both liver pathologies, and the only sole parameter that worsened was LDH. Notably, no serious adverse events were observed in these patients. In conclusion, PTX treatment was associated with favorable clinical outcomes and improved inflammatory marker levels in patients with liver cirrhosis and MASLD with COVID‑19.