Tocilizumab for severe COVID-19 pneumonia

We read with interest the study by Giovanni Guaraldi and colleagues,¹ published in The Lancet Rheumatology, which makes an important contribution to the knowledge of the promising therapeutic pathways for severe forms of COVID-19. Unlike antiviral agents, immunomodulatory agents, such as anakinra,² tocilizumab,¹ and dexamethasone³ seem to have become the cornerstone treatment for the cytokine storm that underlies most severe cases of COVID-19. Patients with severe COVID-19 often present with major coagulopathy, with important clinical consequences that have encouraged physicians to progressively modify their anticoagulation treatment regimens for these patients.⁴

To better analyse the level of benefit provided by tocilizumab, Guaraldi and colleagues should specify the number of arterial or venous thromboembolic events observed in their cohort, and specifically detail the proportion of patients receiving therapeutic anticoagulation in both groups. Cohort analyses⁵ have shown the major prognostic role of curative anticoagulation in similar patients, making it essential to adjust the analysis for these data.