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More evidences on which biologic and which pathway is key in severe-critical COVID-19 pneumonia
  1. Gianfranco Ferraccioli
  1. Department of Rheumatology, Policlinico Universitario Agostino Gemelli, Universita' Cattolica del Sacro Cuore, Roma, Lazio, Italy
  1. Correspondence to Professor Gianfranco Ferraccioli, Department of Rheumatology, Policlinico Universitario Agostino Gemelli, Universita' Cattolica del Sacro Cuore, Roma 00168, Lazio, Italy; gianfranco.ferraccioli{at}unicatt.it

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I read with great interest the paper by Della Torre et al on the effects of sarilumab in severe acute respiratory syndrome coronavirus 2 severe-critical pneumonia. They show that sarilumab treated and standard of care (SOC) treated patients present a mortality rate which is statistically not different (n 28 SARI=7% vs n 28 SOC=18%; p=NS).1 These data confirm previous data from the same group; when analysing patients treated with tocilizumab, they showed no statistically significant differences (n 33 SOC=33%, mortality vs tocilizumab (TOCI) n 32=16%, p=NS).2 These data seem to suggest that interleukin (IL)-6 is not the main target. Indeed out of more than 20 studies reported so far in the literature, only half reported clinically significant results (paper submitted). The various studies have so many bias and differences that a definite conclusion is impossible. However, since the approach with biologics has a strong rationale in controlling the …

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