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  • Correspondence on ‘Interleukin-6 receptor blockade with subcutaneous tocilizumab in severe COVID-19 pneumonia and hyperinflammation: case–control study’

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Correspondence
Correspondence on ‘Interleukin-6 receptor blockade with subcutaneous tocilizumab in severe COVID-19 pneumonia and hyperinflammation: case–control study’
  1. Martin Sebastian Winkler1,
  2. Peter Korsten2,
  3. Claudia Binder3,
  4. Björn Tampe2
  1. 1 Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
  2. 2 Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
  3. 3 Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany
  1. Correspondence to Dr Björn Tampe, Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany; bjoern.tampe{at}med.uni-goettingen.de

https://doi.org/10.1136/annrheumdis-2020-218836

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    We read with great interest the recent article by Potere et al using interleukin (IL)-6 receptor blockade with subcutaneous tocilizumab in SARS-CoV-2 COVID-19 pneumonia and hyperinflammatory syndrome.1 A potential preventive or therapeutic effect of certain immunomodulatory therapies in COVID-19 has been hypothesised. Among them, corticosteroids, IL-6 or IL-1 antagonists have been reported and successfully used in severe COVID-19 and associated hyperinflammatory syndromes.1–4 The hyperinflammation observed in adult patients with severe COVID-19 resembles a cytokine release syndrome (CRS) associated with CD4+ and CD8+ T-cell lymphopaenia and increased cytokine levels, including IL-6, correlating with clinical severity.5–9 In contrast to CRS, immune reconstitution inflammatory syndrome (IRIS) is an exaggerated inflammatory response driven by predominant CD4+ T helper cells that have been reported secondary to previous initiation of antiretroviral therapy (ART) when the immune system begins to recover following treatment with ART.10 Since ART for COVID-19 is among the leading drug candidates in this pandemic, a clear sense for associated hyperinflammatory syndromes is required.11 We describe here a case of …

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