Neither earlier nor late tocilizumab improved outcomes in the intensive care unit patients with COVID-19 in a retrospective cohort study

Tocilizumab (TCZ), a recombinant monoclonal antibody against the interleukin (IL)-6 receptor, has been proposed as a potential therapy for severe SARS-CoV-2 pneumonia based on observational studies.1 Recently, a strategy involving a course of high-dose glucocorticoids, followed by TCZ if needed (in 43% of patients), was shown to improve mortality in patients with rapid respiratory deterioration plus elevation of at least two out of three biomarkers (C reactive protein (CRP), ferritin and/or D-dimer).2 Nevertheless, a short-term use of TCZ is not free from serious adverse events, and the efficacy data, although promising, are preliminary.3\n\nThe timing of anti-inflammatory treatments in relation to the stage of disease seems to be important in patients with COVID-19.4 Therefore, the objective of our retrospective study was to assess the efficacy of earlier and late intravenous TCZ, that is, prior to and after initiation of mechanical ventilation, respectively, in reducing mortality in a cohort of patients with severe COVID-19 pneumonia who required support in intensive care unit (ICU).\n\nIn March 2020, the Russian Ministry of Health set up a Federal Center at the Sechenov University (Moscow) to provide virtual support for the ICU physicians caring for patients with COVID-19.5 All local COVID-19 hospitals were proposed to submit medical records of critically ill patients via secure network to the Federal Center giving urgent advice on the critical care management. For this study, we selected consecutive ICU patients whom TCZ administration was recommended given the presence of bilateral …