Infliximab against severe COVID-19-induced cytokine storm syndrome with organ failure—a cautionary case series
Andreas Stallmach, Andreas Kortgen, Falk A. Gonnert, Sina M. Coldewey, Philipp A. Reuken, Michael Bauer
Abstract
The severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic has prompted search for therapeutics tackling both the pathogen and the overwhelming host response, on an unprecedented scale.In a minority of patients, the disease may cause frequently lethal complications from acute respiratory distress syndrome to multisystem organ failure presumably driven by a cytokine storm [1].Therefore, anti-cytokine therapies may be helpful to prevent tissue injury.However, these antiinflammatory drugs constitute double-edged swords; while they can prevent organ damage, they increase the risk of concomitant (super)infection.Recently, Neurath argued for a protective effect of tumor necrosis factor (TNF) inhibitors in severe COVID-19 [2].Specifically, TNF may aggravate lymphopenia through direct killing via TNF/TNFR1 signaling in T cells [3], and T cell dysfunction reflects an important yet underestimated target for immunomodulatory interventions [4].Thus, anti-TNF strategies may be an interesting option in severe COVID-19.This is supported by data from patients with inflammatory bowel disease (IBD) already on anti-TNF treatment.As of June 16, 2020, outcome data from 1511 IBD patients with COVID-19, among them, 433 patients on anti-TNF, are available from the SECURE-IBD registry [5].Of these, 16% were hospitalized but only three patients (0.7%) died.Compared to other anti-inflammatory drugs such