id	author	title	date	pages	extension	mime	words	sentences	flesch	summary	cache	txt
cord-276711-y74zr7fn	Winthrop, Kevin L	To immunosuppress: whom, when and how? That is the question with COVID-19	2020-08-04		.txt	text/plain	2452	114	42	1 After a difficult March 2019 of high hospitalisation and death rates with COVID-19, on 1 April their institution started a standard protocol of treating patients with COVID-19 with high-dose methylprednisolone for 5-7 days during which time individuals not showing clinical improvement were also given the interleukin 6 (IL-6) receptor-blocking agent tocilizumab. An early observational report from China that used propensity methods to match steroid-treated COVID-19 cases to noncases suggested non-significant trends towards worse outcomes among those using 40-50 mg of methylprednisolone per day compared with those not using steroids. 19 Contrary to this study, an institutional cohort at the University of Michigan of patients with COVID-19 on mechanical ventilation suggested a strong survivor benefit for those using tocilizumab, as mortality was nearly halved, despite an increase in secondary bacterial infections. Their phase 2/3 adaptive trial first reported that in phase 2, sarilumab was not effective in patients with less severe COVID-19 pneumonia (ie, those not mechanically ventilated 27 ).	./cache/cord-276711-y74zr7fn.txt	./txt/cord-276711-y74zr7fn.txt