• inflammation
• cytokines
• biological therapy
• immune system diseases

Many patients with severe COVID-19 rapidly progress to critical disease with refractory hypoxemia requiring invasive mechanical ventilation (IMV).1 Elevated levels of C reactive protein (CRP) and interleukin-6 (IL-6), reflecting an hyperinflammatory response, identify patients at risk of progression to refractory hypoxemia and death.2 Recent evidences suggested that high-dose intravenous tocilizumab (TCZ), a humanised anti-IL-6 receptor antibody, may rapidly reduce fever and inflammatory markers, and improve oxygenation in severe to critical COVID-19.3–5 Data on the safety and efficacy of subcutaneous TCZ, already approved for the treatment of rheumatoid arthritis, are limited. The aim of this study was to compare the clinical course and outcomes of patients treated with subcutaneous TCZ on top of standard of care (SOC) with those of patients receiving SOC only.

In this retrospective case–control study, we treated with TCZ 324 mg, given as two concomitant subcutaneous injections, all consecutive patients at Pescara General Hospital, Italy between 28 March and 21 April 2020, with laboratory-confirmed COVID-19 pneumonia (involving ≥20% of lung parenchyma on chest CT), hyperinflammation (CRP ≥20 mg/dL), hypoxemia (oxygen saturation <90% on room air) requiring supplemental oxygen through nasal cannulas or mask, who had no contraindications to treatment such as bacterial or fungal infection, neutropenia or liver injury. Patients signed an informed consent for the off-label use of TCZ. We reviewed all patients hospitalised …