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Correspondence response
Targeting IL-6 in COVID-19. Response to: ‘Rational use of tocilizumab in COVID-19’ by Jain and Sharma
  1. Pier Leopoldo Capecchi,
  2. Pietro Enea Lazzerini
  1. Department of Medical Sciences, Surgery and Neurosciences, Section of Internal Medicine, COVID-19 Unit, Siena University Hospital, Siena, Toscana, Italy
  1. Correspondence to Professor Pier Leopoldo Capecchi, Department of Medical Sciences Surgery and Neurosciences. Section of Internal Medicine. COVID-19 Unit, Siena University Hospital, Siena 53100, Italy; capecchipl{at}unisi.it

https://doi.org/10.1136/annrheumdis-2020-218627

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    Dear Editor,

    Siddharth and Sharma1 suggest caution in using interleukin-6 (IL-6) receptor blocking agents, namely tocilizumab, in the treatment of patients with COVID-19 infection, particularly those requiring invasive mechanical ventilation because of the increased risk of infections and bowel perforation, possibly also masked by the anti-inflammatory activity of the agent.1 Generally speaking, this is a fully acceptable principle to be observed as caution when using drugs is a common rule in the clinical setting. Thus, no doubt that the use of tocilizumab should be carefully evaluated in individual cases. Nevertheless, the same authors state that ‘the efficacy data are promising (although preliminary)’.

    Specifically regarding safety, Siddharth and Sharma quote that a 13% higher risk of new infections was seen with tocilizumab when added to standard of care.2 Indeed, in the study by Guaraldi et al,2 24 (13%) …

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    Footnotes

    • Handling editor Josef S Smolen

    • Collaborators COVID-19 team of the Siena University Hospital—AOUS Luca Volterrani, Maria Antonietta Mazzei, Barbara Rossetti, Giacomo Zanelli, David Bennett, Elena Bargagli, Federico Franchi, Sabino Scolletta, Matteo Cameli, Serafina Valente, Luca Cantarini, Bruno Frediani.

    • Contributors PLC: conception and design of the work, acquisition, analysis or interpretation of data, drafting the work, final approval of the version published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PEL: substantial contribution to the conception or design of the work and revising the manuscript critically for important intellectual content, final approval of the version published.

    • 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.

    • Provenance and peer review Commissioned; internally peer reviewed.

    Linked Articles

    • Correspondence
      Rational use of tocilizumab in COVID-19
      Siddharth Jain Shefali Khanna Sharma
      Annals of the Rheumatic Diseases 2020; 81 e213-e213 Published Online First: 31 Jul 2020. doi: 10.1136/annrheumdis-2020-218519