Authors writing in Lancet propose that there is sufficient evidence and an urgent need for anti-TNF therapy trials in the fight against COVID-19.
Deaths from COVID-19 are chiefly due to a major immune inflammatory response and diffuse alveolar damage. The pro-inflammatory cytokine upregulation (interleukin (IL)-1, IL-6, TNF, and interferon γ) documented in this disease is a valid target for anti-TNF therapy.
Among the many anti-inflammatory candidates for COVID-19, only a few anti-TNF antibodies such as (infliximab or adalimumab) are potentially effective, widely available, and have a well-established safety profile. This treatment should be evaluated in patients with COVID-19 on hospital admission to prevent progression to the requirement of intensive care support.
Blockade of TNF alone is clinically effective in many diseases, despite the presence of other pro-inflammatory cytokines and mediators. A single infusion of anti-TNF antibody might reduce some of the processes that occur during COVID-19 lung inflammation, reducing TNF and other inflammatory mediators, cellularity, and exudate.
The best time for this therapy in patients with COVID-19 is as early as possible after hospital admission because patients will already have initiated anti-viral immunity for several days.
There is sufficient evidence to support clinical trials of anti-TNF therapy in patients with COVID-19. Study subjects should be initiated on this therapy as early as possible. If anti-TNFs are beneficial and safe in hospitalised subjects, out of hospital treatment of COVID-19 patients at high risk could be considered.