• inflammation
• cytokines
• biological therapy
• anti-inflammatory agents
• non-steroidal

We thank Jain and Sharma1 for their interest in our recent report on interleukin-6 (IL-6) receptor blockade with subcutaneous tocilizumab (324 mg, given in two concomitant 162 mg doses) in patients with severe COVID-19 pneumonia and hyperinflammation.2 Jain and Sharma bring up an important point regarding the safety profile of subcutaneous tocilizumab in patients with COVID-19 at risk of concomitant bacterial infections.1 As already concisely described, in our case–control series, only relatively young patients with severe COVID-19 pneumonia, requiring oxygen support through nasal cannulas or masks, hyperinflammation (C-reactive protein >20 mg/dL) and no contraindications to tocilizumab, including suspected concomitant bacterial infection, were included.2 Well aware of the potential adverse effects of tocilizumab, our screening protocol to rule out concomitant bacterial infection was based on medical history, collected at the time of and during hospitalisation in advance of tocilizumab administration, absolute white blood cell, neutrophil and lymphocyte counts, serial procalcitonin (PCT) values, which were persistently <0.1 ng/mL in most patients, as well as imaging testing assessing for concomitant infection sites outside the lungs. Indeed, several patients were cautiously excluded due …