Introduction

Despite the reduction in the mortality rate of COVID-19, SARS-CoV-2 infection remains one of the major worldwide health concerns, particularly in older adults, unvaccinated individuals, and patients with underlying diseases, or immunocompromised conditions [1]. Few medications with antiviral properties including Nirmatrelvir/Ritonavir (Paxlovid), Remdesivir, and Molnupiravir have been authorized for treatment of mild to moderate COVID-19 in high-risk patients [2]. Because of the detrimental role of inflammation and excessive immune response in COVID-19 patients, it’s crucial to lessen the side effects of SARS-CoV-2 infection by pharmacological agents [3]. Accordingly, corticosteroids such as dexamethasone have beneficial effects on hospitalized patients with COVID-19 who need respiratory support [4]. Other therapies for COVID-19 such as monoclonal antibodies, anti-thrombotics, and immunotherapies are also under investigation [5].
Infliximab, a chimeric monoclonal antibody against TNF-α indicated for management of inflammatory/autoimmune disorders like Rheumatoid Arthritis and Psoriasis, has demonstrated promising role in the management of SARS-CoV-2 infection [6].
Current studies on the pathophysiologic mechanisms of COVID-19 propose that hyper-reactive immune response and increased generation of cytokines such as TNF-α, interleukin (IL)-6, IL-2, IL-7, and IL-10 (called cytokine release syndrome) play a pivotal role in worsening the signs and symptoms of this disease [7]. TNF-α, one of the essential pro-inflammatory cytokines during cytokine release syndrome, intensifies the severity of COVID-19 infection mainly through inducing interaction of the SARS-CoV-2 with angiotensin-converting enzyme 2 (ACE-2) in respiratory system, cytokine release syndrome [7], and auto-immune response [8]. Therefore, TNF-α is a potential target in COVID-19 patients with inappropriate activity of immune system and may lead to better management of this infection [9]. Infliximab binds to TNF-α and thereby inhibits the biological activity of soluble and transmembrane forms of this inflammatory cytokine [10]. Infliximab can also lyse inflammatory immune cells through binding transmembrane TNF-α and subsequently impair the excessive inflammatory response [11].
Herein, we set out a systematic review and meta-analysis on the role of Infliximab in terms of its effectiveness, and safety in the management of COVID-19.