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  • High dosage of methylprednisolone as a rescue, second-line treatment in COVID-19 patients who failed to respond to tocilizumab

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Correspondence
High dosage of methylprednisolone as a rescue, second-line treatment in COVID-19 patients who failed to respond to tocilizumab
  1. Edoardo Conticini1,
  2. Federico Franchi2,
  3. David Bennett3,
  4. Serafina Valente4,
  5. Maria A Mazzei5,
  6. Elena Bargagli3,
  7. Luca Volterrani5,
  8. Sabino Scolletta2,
  9. Bruno Frediani1
  1. 1 Rheumatology Unit, Department of Medical Sciences, Surgery and Neuroscience, University of Siena, Siena, Italy
  2. 2 Anesthesia and Intensive Care Unit, Department of Medical Sciences, Surgery and Neuroscience, University of Siena, Siena, Italy
  3. 3 Respiratory Disease and Lung Transplant Unit, Department of Medical Sciences, Surgery and Neuroscience, University of Siena, Siena, Italy
  4. 4 Cardiology Unit, Department of Medical Biotechnologies, University of Siena, Siena, Italy
  5. 5 Diagnostic Imaging Unit, Department of Medical Sciences, Surgery and Neuroscience, University of Siena, Siena, Italy
  1. Correspondence to Dr Edoardo Conticini, Rheumatology Unit, University of Siena, Siena 53100, Italy; conticini.edoardo{at}gmail.com

https://doi.org/10.1136/annrheumdis-2020-218761

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    We read with interest the article by Ramiro et al 1 about a cohort of patients affected by severe COVID-19 pneumonia. The authors evidenced the efficacy of 5 days of methylprednisolone (MP) (a single bolus of 250 mg, followed by 80 mg on days 2–5) plus, in case of insufficient response, tocilizumab (TCZ) 8 mg/kg, in reducing mortality and preventing invasive ventilation (IV).

    As the massive lung damage during COVID-19 pneumonia is thought to be caused by an aberrant inflammatory response mediated by a massive release of inflammatory cytokines and chemokines, the use of biological immunosuppressants has been widely proposed. The rationale supporting their use is not only an antiviral effect,2 but the selective anti-inflammatory role and the capability of interrupting the cytokine cascade eventually responsible for lung failure.

    TCZ, a monoclonal antibody directed against interleukin 6 (IL-6) receptor, was the first biological drug administered in a Chinese cohort of patients. Despite preliminary promising data, recent reviews and meta-analysis did not find statistically significant differences, in terms of mortality, intensive care unit (ICU) admission and requiring of IV, between patients treated with TCZ …

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    Footnotes

    • Contributors EC wrote the article, BF supervised the work, BF, FF, SV and DB conceived the protocol scheme, EB, LV, SS, MAM.

    • 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 involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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