The Potential for Repurposing Anti-TNF as a Therapy for the Treatment of COVID-19

Philip C Robinson; David F L Liew; Jean W Liew; Claudia Monaco; Duncan Richards; Senthuran Shivakumar; Helen L Tanner; Marc Feldmann

doi:10.1016/j.medj.2020.11.005

The Potential for Repurposing Anti-TNF as a Therapy for the Treatment of COVID-19

Med. 2020 Dec 18;1(1):90-102. doi: 10.1016/j.medj.2020.11.005. Epub 2020 Dec 3.

Authors

Philip C Robinson^{1

2}, David F L Liew^{3

4}, Jean W Liew⁵, Claudia Monaco⁶, Duncan Richards^{6

7}, Senthuran Shivakumar⁴, Helen L Tanner^{1

2}, Marc Feldmann⁶

Affiliations

¹ University of Queensland Faculty of Medicine, Herston, Queensland, Australia.
² Department of Medicine, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia.
³ Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
⁴ Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, Victoria, Australia.
⁵ Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
⁶ Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford OX3 7LD, UK.
⁷ Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford OX3 7LD, UK.

Abstract

Coronavirus disease 2019 (COVID-19) currently has few effective treatments. Given the uncertainty surrounding the effectiveness and uptake of a vaccine, it is important that the search for treatments continue. An exaggerated inflammatory state is likely responsible for much of the morbidity and mortality in COVID-19. Elevated levels of tumor necrosis factor (TNF), a key pro-inflammatory cytokine, have been shown to be associated with increased COVID-19 mortality. In patients with rheumatoid arthritis, TNF blockade reduces not only biologically active TNF but other pro-inflammatory cytokines important in COVID-19 hyperinflammation. Observational data from patients already on anti-TNF therapy show a reduced rate of COVID-19 poor outcomes and death compared with other immune-suppressing therapies. Anti-TNF has a long history of safe use, including in special at-risk populations, and is widely available. The case to adequately assess anti-TNF as a treatment for COVID-19 is compelling.

Keywords: SARS-CoV-2; coronavirus disease-2019; glucocorticoids; pandemic; tumor necrosis factor.

Publication types

Review

MeSH terms

COVID-19 Drug Treatment*
Cytokines
Humans
SARS-CoV-2
Tumor Necrosis Factor Inhibitors / therapeutic use
Tumor Necrosis Factor-alpha

Substances

Cytokines
Tumor Necrosis Factor Inhibitors
Tumor Necrosis Factor-alpha