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Response to: ‘Rational use of tocilizumab in COVID-19’ by Jain and Sharma
  1. Nicola Potere1,2,
  2. Marcello Di Nisio3,4,
  3. Donatella Cibelli5,
  4. Rosa Scurti6,
  5. Antonella Frattari7,
  6. Ettore Porreca1,
  7. Antonio Abbate2,
  8. Giustino Parruti5
  1. 1Department of Medical, Oral and Biotechnological Sciences, Università degli Studi Gabriele d'Annunzio, Chieti, Italy
  2. 2VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
  3. 3Department of Medicine and Ageing Sciences, Università degli Studi Gabriele d'Annunzio, Chieti-Pescara, Italy
  4. 4Department of Vascular Medicine, Amsterdam UMC Location AMC, Amsterdam, North Holland, Netherlands
  5. 5Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
  6. 6Geriatric Medicine Unit, Pescara General Hospital, Pescara, Italy
  7. 7Intensive Care Unit, Pescara General Hospital, Pescara, Italy
  1. Correspondence to Dr Giustino Parruti, Infectious Diseases Unit, Pescara Hospital, Pescara, Pescara, Italy; parrutig{at}

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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 …

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