key: cord-1052153-ovq2n3wk
authors: Cortegiani, Andrea; Ippolito, Mariachiara; Einav, Sharon
title: Rationale and evidence on the use of tocilizumab in COVID-19: a systematic review. Authors' reply
date: 2020-10-21
journal: Pulmonology
DOI: 10.1016/j.pulmoe.2020.10.003
sha: 879817a0eda212b2d6dbb4fec0275cae0d61e8e9
doc_id: 1052153
cord_uid: ovq2n3wk

nan

The results of these trials confirm that findings from nonrandomized trials should be interpreted with caution and that such caution is warranted particularly during public health emergencies when large numbers of patients may subsequently receive redundant treatments. As discussed by the authors in the context of tocilizumab and exemplified also by the hydroxychloroquine landslide (3), experimental drugs are not always harmless, particularly when indiscriminately used. Patient safety should always be prioritized, which is why experimental drugs must be administered within the framework of registered RCTs that are accompanied by appropriate monitoring and regulation.

Research methodology may have also contributed to the negative findings of the above-mentioned RCTs. One example of a potential determinant of outcome in relation to treatment is the timing of administration in respect to the clinical phase of the disease (4).

Another is the treatment dose. Case mix may also have diluted the results; there may be sub-populations of COVID-19 patients who do actually benefit from receiving tocilizumab.

Hopefully the full reports of the COVACTA and EMBACTA trials will shed some light on these questions and more. These analyses combined with additional data from the interventional tocilizumab arm of the RECOVERY trial (www.recoverytrial.net) may yet change our perspective on this drug. To summarize, although oft repeated, the following rhetoric is simply the truth: more (high quality) research is urgently needed.

Interleukin-6 blockade with tocilizumab in COVID-19: Does it live up to its hype

Rationale and evidence on the use of tocilizumab in COVID-19 : a systematic review

Update I. A systematic review on the efficacy and safety of chloroquine/hydroxychloroquine for COVID-19

COVACTA trial raises questions about tocilizumab's benefit in COVID-19