Tocilizumab is a recombinant humanized monoclonal IL-6 receptor antibody indicated for the treatment of severe rheumatoid arthritis and other inflammatory disorders.

Following clinical observation from China, a series of Italian studies have been carried out to evaluate the off-label use of tocilizumab in COVID-19 patients.

The European Journal of Internal Medicine (EJIM) has recently accepted for publication three articles on the off-label use of tocilizumab in patients with severe COVID-19. These studies suggest that tocilizumab may have a therapeutic value by improving the outcome of patients with severe COVID-19 infections. However, as Prof Marcel Levi points out in an editorial accompanying the articles, 'these results need confirmation in a prospective and properly controlled randomized trial before this treatment can be advocated'.

At the same time, Levi continues, 'it is tempting to speculate why specific anti-IL-6 targeted treatment would be more effective than more general anti-inflammatory interventions. Apart from the prominent role of IL-6 in the host-defense response in COVID-19 it may be that specific beneficial effects of tocilizumab on the coagulation abnormalities associated with COVID-19 are also relevant'.

Owing to the interest so far raised by these articles, the Editors decided to hold a live web session for an open discussion.

Editorial: Tocilizumab for severe COVID-19: A promising intervention affecting inflammation and coagulation

M. Levi


Impact of low dose tocilizumab on mortality rate in patients with COVID-19 related pneumonia

R. Capra, N. De Rossi, F. Mattioli, G. Romanelli, C. Scarpazza, M.P. Sormani, S. Cossi


Off-label use of tocilizumab for the treatment of SARS-CoV-2 pneumonia in Milan, Italy

Valentina Morena, L. Milazzo, L. Oreni, G. Bestetti, T. Fossali, C. Bassoli, A. Torre, M.V. Cossu, C. Minari, E. Ballone, A. Perotti, D. Mileto, F. Niero, S. Merli, A. Foschi, S. Vimercati, G. Rizzardini, S. Sollima, L. Bradanini, L. Galimberti, R. Colombo, V. Micheli, C. Negri, A.L. Ridolfo, L. Meroni, M. Galli, S. Antinori, M. Corbellino


Efficacy and safety of tocilizumab in severe COVID-19 patients: a single-centre retrospective cohort study

Corrado Campochiaro, E. Della-Torre, G. Cavalli, G. De Luca, M. Ripa, N. Boffini, A. Tomelleri, E. Baldissera, P. Rovere-Querini, A. Ruggeri, G. Monti, F. De Cobelli, A. Zangrillo, M. Tresoldi, A. Castagna, L. Dagna, for the TOCI-RAF Study Group


Prof Lorenzo Dagna

Vita-Salute San Raffaele University, Milan, Italy

Dr Flavia Mattioli

ASST Spedali Civili, Brescia, Italy

Dr Laura Milazzo

ASST Fatebenefratelli Sacco, Milan, Italy


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