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In this issue of JAMA Internal Medicine, 3 important articles1-3 explore the use of tocilizumab in coronavirus disease 2019 (COVID-19) pneumonia. Tocilizumab is a humanized monoclonal antibody that binds human interleukin 6 (IL-6) receptors. It is used routinely in inflammatory arthritis, giant cell arteritis, and cytokine release syndrome after chimeric antigen receptor T-cell therapy. Its use recently proliferated after early observations from China showed increased risk of death in patients with COVID-19 and elevated IL-6 levels,4 and nonrandomized studies5,6 suggested benefit from tocilizumab treatment. In many centers across the United States, off-label use of tocilizumab became standard of care for patients with COVID-19 and evidence of hyperinflammation. However, practice patterns have varied, and guidelines from the National Institutes of Health7 and the Infectious Disease Society of America8 now recommend against the use of tocilizumab except in the context of a clinical trial. Although an increasing number of observational studies9-11 have suggested mortality benefit, data from randomized clinical trials (RCTs) of tocilizumab in COVID-19 are sorely needed to inform clinical practice.
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Parr JB. Time to Reassess Tocilizumab’s Role in COVID-19 Pneumonia. JAMA Intern Med. 2021;181(1):12–15. doi:10.1001/jamainternmed.2020.6557
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