University of Queensland Faculty of Medicine, Herston, Queensland, Australia.
Department of Medicine, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia.
Med. 2020 Dec 18;1(1):90-102. doi: 10.1016/j.medj.2020.11.005. Epub 2020 Dec 3.
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.
新型冠状病毒病 2019（COVID-19）目前尚无有效的治疗方法。鉴于疫苗的有效性和接受程度存在不确定性，继续寻找治疗方法非常重要。COVID-19 患者的发病率和死亡率高，可能与炎症状态过度有关。已证明肿瘤坏死因子（TNF）水平升高与 COVID-19 死亡率增加有关，TNF 是一种关键的促炎细胞因子。在类风湿关节炎患者中，TNF 阻断不仅可减少具有生物活性的 TNF，还可减少 COVID-19 过度炎症中其他重要的促炎细胞因子。来自已接受抗-TNF 治疗的患者的观察性数据表明，与其他免疫抑制疗法相比，COVID-19 不良结局和死亡的发生率降低。抗-TNF 的使用历史悠久，安全性良好，包括在特殊高危人群中使用，且广泛可用。充分评估抗-TNF 作为 COVID-19 治疗药物的理由非常充分。
