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.