Anti-TNF therapy inhibits fever in cerebral malaria

The clinical effects of a murine monoclonal antibody (CB0006) directed against tumour necrosis factor were investigated in an open study of 41 Gambian children receiving otherwise conventional therapy for cerebral malaria. Ten children received a single i.v. dose of CB0006 at 0.1 mg/kg, 10 received 1 mg/kg, 10 received 5 mg/kg, and 11 were randomly selected as controls. CB0006 rapidly formed complexes with tumour necrosis factor, which were cleared from the circulation over several days. This was associated with a dose-dependent increase in total plasma tumour necrosis factor levels and a dose-dependent reduction of fever, implying that CB0006 inhibits tumour necrosis factor by retaining it in the circulation and reducing its availability to tissue receptors. Parasite clearance rates were not impaired. The fatality rate (29% overall) was similar in CB0006-treated patients and controls, but evaluation of possible effects on mortality requires a much larger blinded study. These data show that tumour necrosis factor is involved in the pathogenesis of malaria fever, and are the first direct evidence that inhibition of a specific endogenous pyrogen can attenuate fever in man.