Accumulating evidence suggests anti-TNF therapy needs to be given trial priority in COVID-19 treatment

Authors: Philip C Robinson, Duncan Richards, Helen L Tanner, Marc Feldmann

The COVID-19 pandemic continues to wreak havoc on global health-care systems and to claim an increasing number of lives. Although some treatments have shown promise, including dexamethasone and remdesivir, problems remain with access to medication and high mortality despite treatment. Patient selection also appears to be critical, with some patient groups benefitting from treatment, but not others. One potential treatment that deserves higher priority in COVID-19 trials, based on the documented evidence of its effects, is the biological agent anti-TNF.Feldmann and colleagues1 described the rationale for trialling anti-TNF therapies in COVID-19. These therapies neutralise TNF, a major component of the cytokine response that is part of the damaging excess inflammatory phase of COVID-19, which is termed hyperinflammation or cytokine release syndrome. This hyperinflammatory response in COVID-19 is characterised by elevated concentrations of serum TNF, interleukin (IL)-6, and IL-8, but relatively little IL-1.2 However, IL-1 has a short serum half-life, and mononuclear transcriptome data show that genes and pathways upregulated by TNF, IL-1β, and type I interferon predominate.3 A major component of deteriorating lung function in patients with COVID-19 is capillary leak, a result of inflammation driven by key inflammatory cytokines: TNF, IL-1, IL-6, and vascular endothelial growth factor. Administration of anti-TNF to patients for treatment of autoimmune disease leads to reductions in all of these key inflammatory cytokines.45 It is therefore conceivable that anti-TNF therapy could reduce inflammation-driven capillary leak in COVID-19 and have a major impact on the need for ventilation and mortality.

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TNF Biologics and COVID-19: What Autoimmune Patients Need to Know


If you’re taking a type of medication known as tumor necrosis factor inhibitors, also called anti-TNF or TNFis, you may be wondering how these drugs could impact your chances of contracting COVID-19, or having more severe complications from it. After all, the common cold or other upper respiratory tract infections can be more common in people taking anti-TNF inhibitors.

On the other hand, some rheumatologists are pointing out that TNF biologics may actually be protective against COVID-19 inflammation — and they are calling for more clinical trials to study these drugs as a potential COVID treatment.

No wonder there is confusion and anxiety among the people who take these medications to manage conditions like rheumatoid arthritis, psoriasis, and Crohn’s disease.

While more research is needed to fully understand the impact of these medications on COVID-19, at least there is some preliminary data from the first few months of the pandemic, which is helping doctors and researchers make decisions help keep you healthy and safe.

We talked with top rheumatologist to help quell your fears and answer your questions. Read on to learn about how anti-TNF biologics work in the body, what the latest coronavirus research says, and how to best manage your inflammatory condition and minimize your risk of COVID-19.

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