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  • Correspondence on ‘Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study’

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Correspondence
Correspondence on ‘Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study’
  1. Aimilios Kaklamanos,
  2. Panagiotis Karamichalos,
  3. Panayiotis G Vlachoyiannopoulos,
  4. Athanasios G Tzioufas
  1. Department of Pathophyiology, National and Kapodistrian University of Athens Faculty of Medicine, Athens, Greece
  1. Correspondence to Professor Athanasios G Tzioufas, Department of Pathophysiology, National and Kapodistrian University of Athens School of Medicine, Athens 157 72, Greece; agtzi{at}med.uoa.gr

https://doi.org/10.1136/annrheumdis-2021-220411

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    One of the very first publications showing promising results from the blockade of interleukin-6 signalling by the use of tocilizumab in patients with severe COVID-19 was that of Ramiro et al in July 2020, during the first wave of the pandemic.1 However, the results from further studies and randomised controlled trials regarding this issue hitherto remain inconclusive.2–7 To further support the work done by Ramiro et al (as well as those of other researchers), we would like to report the successful use of a single dose of intravenous 8 mg/kg tocilizumab in our department as a compassionate treatment in three consecutive patients during the second wave of the pandemic. These patients exhibited a rapid (within 24–72 hours) respiratory deterioration, despite already receiving the maximum indicated treatment. The administration of tocilizumab halted the further deterioration of these patients and prevented them from being intubated.

    Patient 1, a middle-aged overweight man with medical history of arterial hypertension, presented to the emergency room (ER) on day 8 after initiation of COVID-19 symptoms, due to dyspnoea. He was tachypneic (respiratory ratio (RR)=25 breaths/min), while receiving 3 L/min of oxygen via a nasal cannula (arterial oxygen partial pressure (pO2)/fraction of inspired oxygen (FiO2)=216.6 mm Hg). His laboratory tests showed increased C reactive protein (CRP) …

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    Footnotes

    • Contributors AK, PK, PGV and AGT were responsible for handling the patients and wrote 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, conduct, reporting or dissemination plans of this research.

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

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