Intended for healthcare professionals

  1. Erin K McCreary, clinical assistant professor1,
  2. Nuala J Meyer, associate professor2
  1. 1Department of Medicine, Division of Infectious Diseases, UPMC Health System and the University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
  2. 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
  1. Correspondence to: E K McCreary mccrearye3{at}upmc.edu

The signals are broadly positive, but not definitive

More than two million people have so far died from coronavirus disease 2019 (covid-19) globally. With hospitals and intensive care units at or exceeding capacity in much of the world, discovering life-saving treatments is second only to global vaccination efforts to stop the horrific impact of this disease. Early in the pandemic, elevated inflammatory markers were found to be associated with severe covid-19 and death, leading to exploration of immunomodulatory treatments in clinical trials.1

Tocilizumab, a humanized monoclonal antibody that inhibits interleukin 6 mediated signaling by blocking interleukin 6 from binding to receptors, was an early front runner in the race to find treatments for severely ill patients.2345 However, conflicting results from several randomized clinical trials, along with corticosteroids becoming standard care for patients admitted to hospital who required oxygen, tempered enthusiasm for its use.6789 Now, in a linked paper, Veiga and colleagues (doi:10.1136/bmj.n84) report a randomized trial from Brazil that compared tocilizumab with standard care in 129 patients with covid-19.10 Surprisingly, the trial was stopped early because tocilizumab was associated with increased deaths at day 15 (17% v 3%, odds ratio 6.42, 95% confidence interval 1.59 to 43.2). So, should tocilizumab be …

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