J Intern Med. 2020 Aug 3. doi: 10.1111/joim.13162. Online ahead of print.
among patients with COVID-19 who require treatment in intensive care for acute respiratory distress syndrome (ARDS), mortality rates have been reported between 16 - 78% (1). In patients who are discharged alive, an increased risk of sequelae from COVID-19 is anticipated (2). The hyperinflammatory response induced by SARS-CoV-2 is pivotal in the pathogenesis of COVID-19 and is accompanied by an upregulated expression of interleukin 6 (IL-6) that correlates with disease severity (3). Tocilizumab, a monoclonal antibody against the IL-6 receptor originally licensed for the use in rheumatoid arthritis, is also approved for treatment of chimeric antigen receptor T cell-related cytokine release syndromes and secondary hemophagocytic syndromes that share important features with the hyperinflammatory phase in COVID-19. Several small studies from China and Europe have reported promising results of the treatment with tocilizumab in patients with COVID-19, preventing the need for admission to an intensive care unit and improving clinical outcomes (4,5). We aimed to evaluate the impact of treatment with tocilizumab compared to routine care on important clinical outcomes in critically ill patients admitted to an intensive care unit with ARDS due to COVID-19.