Design of studies of pentoxifylline in COVID-19
Study of pentoxifylline in COVID-19 should be feasible and ethical given
the well-described adverse event profile of the drug. A randomised study
in COVID-19 patients presenting with, or at high risk of, pulmonary
complications could be designed with pentoxifylline versus a placebo or
comparator treatment, alongside standard of care. pentoxifylline has
been used at 400-1200 mg daily in 400mg doses. Initial study likely
should use 1200 mg daily in divided doses. If there is initial evidence
of benefit with oral pentoxifylline, then study of inhaled
pentoxifylline could be valuable in selected patients. In the future it
will also be logical to study the combination of cytokine-modifying
therapy with direct anti-viral therapeutics (such as the recently
favoured Remdesivir). The efficacy of pentoxifylline can be assessed by
randomised control trials with key endpoints including mortality, need
for ventilatory support, time on ventilatory support, measures of oxygen
exchange efficiency and time in hospital.