Efficacy of Tocilizumab in Patients With COVID-19 ARDS Undergoing Noninvasive Ventilation

Francesco Menzella; Matteo Fontana; Carlo Salvarani; Marco Massari; Patrizia Ruggiero; Chiara Scelfo; Chiara Barbieri; Claudia Castagnetti; Chiara Catellani; Giorgia Gibellini; Francesco Falco; Giulia Ghidoni; Francesco Livrieri; Gloria Montanari; Eleonora Casalini; Roberto Piro; Pamela Mancuso; Luca Ghidorsi; Nicola Facciolongo


Crit Care. 2020;24(589) 

In This Article


The severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is extremely variable, ranging from asymptomatic patients to those who develop pneumonia with acute respiratory distress syndrome (ARDS).[1] The unpredictability of clinical evolution probably depends on viral strain and load, age, and comorbidities.[2] Individual susceptibility of the host may probably modulate the severity of response, in particular cytokine storm, that in some cases evolves to multiple organ dysfunction syndrome and death.[3]

In SARS-CoV infections, elevated levels of serum pro-inflammatory cytokines (IFN-γ, IL-1, IL-6, IL-12, and TGFβ) and chemokines (CCL2, CXCL10, CXCL9, and IL-8) have been detected in patients with severe forms compared to less complicated cases.[4] Even in Middle East respiratory syndrome (MERS) infection, the presence of elevated levels of serum pro-inflammatory cytokines (IL-6 and IFN-α) and chemokines (IL-8, CXCL-10 and CCL5) is documented in the most severe forms compared to the milder ones.[5] With regard to SARS-CoV-2, the most commonly elevated cytokines were IL2, IL-6, IL7, IL10, GSCF, IP10, MCP1, MIP1a, and TNF α, the levels of which were higher in the more compromised patients.[2,6] It is important to note that the levels of IL-6 in the blood of the patients with severe disease were higher than those observed in patients with milder disease and an association between elevated IL-6 serum levels and increased mortality rates was found.[6,7]

Except glucocorticoids (GCs), there are still no really effective therapies for coronavirus disease 2019 (COVID-19).[8] Some evidences suggest that tocilizumab (TCZ), a humanized anti-interleukin 6 (IL-6) receptor monoclonal antibody (mAb), may be effective and avoid the progression of severe COVID-19.[9–13]

The aim of this retrospective case-control study was to analyze the efficacy and safety of TCZ in a cohort of patients with COVID-19 ARDS undergoing noninvasive mechanical ventilation (NIV).