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Targeting IL-6 in COVID-19. Response to: ‘Rational use of tocilizumab in COVID-19’ by Jain and Sharma
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  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

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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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