Summary
We propose a new hypothesis that the established drug pentoxifylline deserves attention as a potential repurposed therapeutic for COVID-19.
Pentoxifylline is an anti-inflammatory agent that suppresses adenosine responses, reduces tumour necrosis factor α, interleukin 1, interleukin 6 and interferon γ and may act to reduce tissue damage during the cytokine storm response to SARS-CoV-2 infection. This agent has been used clinically for many years and has a favourable profile of safety and tolerability. Pre-clinical data support pentoxifylline as effective in cytokine-driven lung damage. Clinical studies of pentoxifylline in radiation and cytokine-induced lung damage in humans are positive and consistent with anti-inflammatory efficacy.
Pentoxifylline is a readily available, off-patent, inexpensive drug suitable for large scale use, including in resource-limited countries.
Current trials of therapeutics are largely focussed on the inhibition of viral processes. We advocate urgent randomised trials of pentoxifylline for COVID-19 as a complementary approach to target the host responses.