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I read with interest the recent case–control study by Potere et al, which describes the potential efficacy and safety of tocilizumab in patients with severe COVID-19 pneumonia and hyperinflammation.1 Since publication of this analysis, new information on anti-inflammatory therapies in COVID-19 has become available. The RECOVERY trial randomised 2104 patients with COVID-19 to receive dexamethasone 6 mg daily or usual care for up to 10 days.2 In the overall cohort, dexamethasone significantly reduced the incidence of 28-day mortality from 26% to 23%. The benefits of dexamethasone on mortality were greatest in those patients undergoing mechanical ventilation (41% vs 29%) or receiving supplemental oxygen without mechanical ventilation (26% vs 23%) at baseline. A clinical trial of sarilumab, another interleukin-6 receptor blocker, failed to meet its primary and key secondary endpoints.3 The lack of efficacy in the sarilumab clinical trial contrasts with the reported efficacy in the Potere et al study. It would be of great interest to analyse the results of the analysis by Potere et al in the context of these findings. In particular, an analysis according to concurrent use of systemic corticosteroids would allow for estimation of whether the benefits in this observational analysis may be attributable to background corticosteroid use.
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Contributors LB is the sole author of this work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Provenance and peer review Not commissioned; internally peer reviewed.