Abstract
Inflammation plays a major role in the pathophysiology of COVID-19, and corticosteroids are validated as initial potent broad-spectrum anti-inflammatory agents. IL-6 is one of the culprit pro-inflammatory cytokines identified for this cytokine storm. Tocilizumab is a recombinant humanized monoclonal antibody that inhibits binding of interleukin (IL)-6 to both membrane and soluble IL-6 receptors. The role of tocilizumab was controversial with conflicting evidence, but recent data validate the use of this agent under specific circumstances of rapidly worsening COVID acute respiratory distress syndrome with escalating respiratory support or gradually worsening COVID-19 pneumonia in a hospital setting. One of the benchmark tocilizumab studies is the REMAP-CAP trial that showed the benefit of IL-6 antagonists in terms of survival, number of organ support-free days, and even probability of discharge from the hospital. This benefit was seen when tocilizumab was administered within 24 h of patients requiring either respiratory or hemodynamic support. A recently concluded meta-analysis showed that tocilizumab treatment predicts better overall survival in COVID-19 patients (hazard ratio [HR] =0.45, 95% confidence interval [CI]: 0.24–0.84, P = 0.01), especially in severe cases (HR = 0.58, 95% CI: 0.49–0.68, P
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