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.