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Correspondence
Rational use of tocilizumab in COVID-19
  1. Siddharth Jain,
  2. Shefali Khanna Sharma
  1. Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
  1. Correspondence to Dr Shefali Khanna Sharma, Clinical Immunology and Rheumatology, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India; sharmashefali{at}hotmail.com

https://doi.org/10.1136/annrheumdis-2020-218519

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    With 12 million cases and half a million deaths (as of 10 July 2020), the corona virus disease (COVID-19) has paralysed healthcare systems the world over. The observations by Potere et al 1 and mechanistic insights by Capecchi et al 2 merit a discussion of important considerations that should be borne in mind before using tocilizumab in severe COVID-19. The available evidence concerning its use, although promising, is preliminary and probably underpowered to detect important safety/efficacy signals.3 4

    Patients with COVID-19 are not free from the risk of a bacterial infection, which could be secondary (nosocomial) or co-primary (community acquired). Concomitant bacterial infections have been reported in 10%–20% of COVID-19 cases and ~50% of COVID-19-related deaths, consistent with, and reminiscent of bacterial infections being the the most common cause of mortality in previous influenza pandemics.5 6 This risk is higher in old age, presence of comorbidities and those requiring invasive mechanical ventilation (all probable candidates for use of tocilizumab). A hesitancy towards the use of CT and fiberoptic bronchoscopy at …

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    Footnotes

    • Contributors SKS and SJ conceptualised the manuscript. SJ wrote the manuscript and SKS critically reviewed it. Both authors approved the final submitted version of the manuscript.

    • 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, or conduct, or reporting, or dissemination plans of this research.

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

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