Is There Still a Place for Tocilizumab in Coronavirus Disease 2019?

Klopfenstein, Timothée; Conrozier, Thierry; Kadiane-Oussou, N’dri Juliette; Gendrin, Vincent; Zayet, Souheil

In this article, we sought to summarize the available evidence of tocilizumab as a treatment for coronavirus disease 2019. Recent tocilizumab randomized trials have not shown clear evidence of efficacy, especially on mortality, in contrast to observational studies. These clinical trials focus on a heterogeneous population of patients (clinical severity and inflammatory stage), and this is possibly one of the reasons that explain heterogeneity of results. However, these same trials have shown some evidence that tocilizumab may reduce intensive care unit admissions and/or mechanical ventilation incidence, which are huge challenges in the severe acute respiratory syndrome coronavirus 2 pandemic. Future clinical trials with primary endpoint built on this assumption are needed (1) to confirm whether tocilizumab reduces mechanical ventilation requirement and (2) to describe the right patient population and optimal timing for tocilizumab administration. Finding the optimal timing for tocilizumab administration and the group of patients who are susceptible to having the greatest benefit are probably the main challenge.