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Correspondence
Correspondence on ‘Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry’ by Gianfrancesco et al. Compassionate use of tocilizumab in severe COVID-19 with hyperinflammation prior to advent of clinical trials – a real-world district general hospital experience
  1. Asim Khan1,
  2. Alice Cole1,
  3. Naveen Bhadauria1,
  4. Munzir El-Hassan2,
  5. Daud Abdulla3,
  6. Thomas Axon1,
  7. Zozik Fattah1,
  8. Jessica J Manson4,
  9. Jeronimo Moreno-Cuesta2,
  10. Dev Mukerjee1
  1. 1Rheumatology Department, North Middlesex University Hospital NHS Trust, London, UK
  2. 2Critical Care Department, North Middlesex University Hospital NHS Trust, London, UK
  3. 3Pharmacy Department, North Middlesex University Hospital NHS Trust, London, UK
  4. 4Rheumatology Department, University College London Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Asim Khan, North Middlesex University Hospital NHS Trust, London N18 1QX, UK; asim.khan7{at}nhs.net

https://doi.org/10.1136/annrheumdis-2020-218528

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    The coronavirus disease 2019 (COVID-19) has resulted in a global pandemic with multiple casualties. Within the UK, specific groups of patients including those with rheumatic diseases requiring significant immunosuppression were advised to shield from the public to protect themselves from COVID-19 during the heart of the pandemic.1 In their important paper, Gianfrancesco et al found lower rates of hospitalisation in patients with rheumatic diseases with COVID-19 who were taking traditional synthetic and biological disease modifying antirheumatic drugs (DMARDs).2 With regard to biologic DMARDs, most of their registry patients were taking tumour necrosis factor inhibitors but did also include other therapies including interleukin-6 (IL-6) antagonists.

    They also provide an interesting suggestion of the potential benefit of biologic DMARD therapy in COVID-19 patients particularly in cases associated with a hyperinflammatory response. Indeed, it has been recognised that subsets of COVID-19 patients can develop a cytokine storm involving the uncontrolled production of cytokines such as IL-6.3 4 Moreover, observational studies suggest the potential benefit of IL-6-antagonism using tocilizumab (TOC).5–7 Internationally, TOC has been used in Italy, China and Ireland.8–10

    Early during the UK pandemic, there was no access to clinical trials. Moreover, our Trust faced the second highest pressure index in the UK in relation to the number of admissions of COVID-19 patients.11 Our …

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    Footnotes

    • Contributors We can confirm that this manuscript has not been published and is not under consideration for publication in another journal. We can also confirm that all authors have contributed to the production of this publication. Dr AK was involved in the entire production of the manuscript, data collection and analysis as well as direct patient care and decision-making. Dr AC helped to put the draft together and proof-reading. Dr NB, Dr ZF and Dr DM were involved directly in patient care and also helped with proof-reading and draft rewrites. Dr ME-H, Mr DA and Dr TA were directly involved in patient care as well as data collection and analysis for the manuscript. Dr JJM was our tertiary care Rheumatologist who helped our local Rheumatology team with patient care. She also proof-read the manuscript and helped with draft rewrites. Finally, Dr JM-C was directly involved with patient care, helped with data collection and also proof-read the manuscript. Overall, each author meets the authorship criteria of the ICMJE.

    • 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.

    • Patient consent for publication Not required.

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

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