Justification for use of pentoxifylline in the complex therapy against COVID-19

Abstract

During COVID-19 pandemic, the world scientific community is seeking for efficient and high-quality means to battle the virus itself and its complications. Unfortunately, so far there is no specific methods to treat COVID-19. The main therapeutic strategies include supporting and controlling approaches. So prevention is the best way to eliminate the viral contagion. In the view of this, the scientists paid their attention to pentoxofylline which has been well-known in medicinal practice for a long time. Pentoxifylline is methylxanthine-derived which has been used for the last three decades to treat remittent limp. When used in clinical doses (max. daily dose — 1200 mg), it improves rheological blood values: it reduces plasma viscosity mostly due to decrease fibrinogen level; it leads to increase of erythrocyte elasticity and decrease of thrombocyte aggregation; it provides the increase of blood filtration due to inhibition of neutrophil activation. Viral infections are usually related to the constant formation of the oxidized products and COVID-19 is not an exception as well. Post-mortem analysis of the people affected with SARS-CoV showed the massive formation of the oxidized phospholipids (OxPL) during acute lung injury (ALI). By showing its anti-oxidant and anti-inflammatory properties, pentoxifylline renews glutathione level, supports mitochondrial viability, inhibits TNF-α production, saves the functions of vascular endothelium which in its turn reduces the length of stay at the hospital and ICU, frequency of multi-organ dysfunctions, mechanical ventilation time and mortality rate. Academic works show that pentoxifylline has anti-inflammatory, anti-oxidant, immune-modulating, anti-viral properties; it also has positive effect on respiratory symptoms alleviation which supports the idea that it can used as the adjuvant therapy for COVID-19 patients. Moreover, it can be also used to treat thrombotic complications at the severe COVID-19.